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 21-40 are pending in this application.
Information Disclosure Statement
The information disclosure statement (IDS) submitted on 9/12/24 are in compliance with the provisions of 37 CFR 1.97. Accordingly, the information disclosure statement is being considered by the examiner.
Examiner’s Comments Relating to Prior Art
The examiner notes that there are no prior art rejections because prior art searches have yielded nothing similar to the claimed invention. This is because the claims contain very specific steps and procedures in the business idea of estimating and displaying healthcare costs. At a high level, the invention is about estimating and displaying healthcare costs based on accuracy, number of estimates, and date range.
More specifically, the claims disclose very specific steps of:
Receiving estimates generated by 1st estimation model; 1st estimate = out-of-pocket cost of 1st service;
Storing the estimates;
Receiving remittances;
1st remittance = 1st estimate;
Storing the remittances;
Generating a total accuracy score for the 1st estimate;
Matching 1st estimate with 1st remittance;
Determining accuracy score for each “element”;
Element = factor that impacts accuracy score of the estimate;
Generating and transmitting display for Payer breakout user interface component with blocks with color determined based on accuracy score of the 1st estimate; and size determined based on number of estimates associated with the 1st payer;
Payer breakout interface component is automatically updated based on change in the total accuracy score of 1st estimate;
Filtering options for user to select date range;
In response to the user selection, update the user interface element to be displayed;
The 1st updated user interface element = 1st payer system info + either (a) change in size OR (b) change in color of the 1st block;
In response to the user 1st date range selection, update the second updated user interface element to be displayed;
Second updated user interface element = subset blocks = number of estimates associated with 1st payer system with the 1st date range;
Receiving second estimates generate by 2nd estimate model;
2nd estimate = elements of 1st estimate;
2nd estimate model uses different weighting than 1st estimate model;
The different weighting is determined based on the total accuracy score of the 1st estimate;
As the claim stated:
“receive, from a service provider system, a first plurality of estimates that are generated by a first estimation model associated with the service provider system,
wherein a first estimate of the first plurality of estimates corresponds to an estimated out-of-pocket cost for a first service rendered by the service provider system, and wherein the first estimate comprises a plurality of elements;
store, in a first data store, the first plurality of estimates;
receive, from a first payer system of a plurality of payer systems, a plurality of remittances,
wherein a first remittance of the plurality of remittances corresponds to the first estimate, and wherein the first remittance comprises an actual out-of- pocket cost for the first service rendered by the service provider system;
store, in a second data store, the plurality of remittances;
generate a total accuracy score for the first estimate by:
matching the first estimate with the first remittance, determining an accuracy score for each element of the plurality of elements,
wherein each of the plurality of elements is associated with at least one factor that impacts accuracy of an estimate, and based on the accuracy score for each of the plurality of elements, determine a total accuracy score for the first estimate;
generate and transmit, to a display device, display instructions that, when executed, cause a user interface element to be displayed by the display device, the user interface element comprising:
a payer breakout user interface component, wherein the payer breakout user interface component comprises a plurality of blocks such that a first block of the plurality of blocks associated with the first payer system comprises (i) a color determined based at least in part on the total accuracy score of the first estimate and (ii) a size determined based at least in part on a number of estimates associated with the first payer system in relation to remaining payer systems of the plurality of payer systems,
wherein the payer breakout user interface component is configured to automatically update the plurality of blocks based at least in part on a change in the total accuracy score of the first estimate, and
one or more filtering options, wherein a first filtering option enables a user to select a date range;
in response to receiving an indication of a user selection of the first block, generate and transmit, to the display device, updated display instructions that, when executed, cause a first updated user interface element to be displayed by the display device,
the first updated user interface element comprising: information associated with the first payer system, and at least one of a change in the size or the color of the first block;
in response to receiving an indication of a user selection of a first date range, cause a second updated user interface element to be displayed,
the second updated user interface element comprising:
a subset of the plurality of blocks, wherein a second block of the plurality of blocks associated with the first payer system comprises a number of estimates associated with the first payer system that are generated on dates within the first date range; and
receive, from the service provider system, a second plurality of estimates that are generated by a second estimation model associated with the service provider system,
wherein a second estimate of the second plurality of estimates comprises the plurality of elements of the first estimate, and
wherein the second estimation model utilizes a different weighting than the first estimation model for at least one element of the plurality of elements, wherein the different weighting is determined based on the total accuracy score of the first estimate (emphasis examiner’s).”
Thus, there are no prior art rejections because prior art searches have yielded nothing similar to the claimed invention – in combination with the referenced claim elements.
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 21-40 are rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more.
Claims 21-40 are directed to a system, method, or product, which are/is one of the statutory categories of invention. (Step 1: YES).
The Examiner has identified independent method claim 32 as the claim that represents the claimed invention for analysis and is similar to independent system claim 21 and product claim 37. Claim 32 recites the limitations of estimating and displaying healthcare costs based on accuracy, number of estimates, and date range.
These limitations, under their broadest reasonable interpretation, cover performance of the limitation as certain methods of organizing human activity. Receiving estimates generated by 1st estimation model; 1st estimate = out-of-pocket cost of 1st service; storing the estimates; receiving remittances; 1st remittance = 1st estimate; storing the remittances; generating a total accuracy score for the 1st estimate; matching 1st estimate with 1st remittance; determining accuracy score for each “element”; element = factor that impacts accuracy score of the estimate; generating and transmitting display for Payer breakout user interface component with blocks with color determined based on accuracy score of the 1st estimate; and size determined based on number of estimates associated with the 1st payer; payer breakout interface component is automatically updated based on change in the total accuracy score of 1st estimate; filtering options for user to select date range; in response to the user selection, update the user interface element to be displayed; the 1st updated user interface element = 1st payer system info + either (a) change in size OR (b) change in color of the 1st block; in response to the user 1st date range selection, update the second updated user interface element to be displayed; second updated user interface element = subset blocks = number of estimates associated with 1st payer system with the 1st date range; receiving second estimates generate by 2nd estimate model; 2nd estimate = elements of 1st estimate; 2nd estimate model uses different weighting than 1st estimate model; the different weighting is determined based on the total accuracy score of the 1st estimate, – specifically, the claim recites: “receive… a first plurality of estimates that are generated by a first estimation model… wherein a first estimate of the first plurality of estimates corresponds to an estimated out-of-pocket cost for a first service rendered by the service provider system, and wherein the first estimate comprises a plurality of elements; store, in a first data store, the first plurality of estimates; receive… a plurality of remittances, wherein a first remittance of the plurality of remittances corresponds to the first estimate, and wherein the first remittance comprises an actual out-of- pocket cost for the first service rendered by the service provider system; store, in a second data store, the plurality of remittances; generate a total accuracy score for the first estimate by: matching the first estimate with the first remittance, determining an accuracy score for each element of the plurality of elements, wherein each of the plurality of elements is associated with at least one factor that impacts accuracy of an estimate, and based on the accuracy score for each of the plurality of elements, determine a total accuracy score for the first estimate; generate and transmit… display instructions that, when executed, cause a user interface element to be displayed by the display device, the user interface element comprising: a payer breakout user interface component, wherein the payer breakout user interface component comprises a plurality of blocks such that a first block of the plurality of blocks associated with the first payer system comprises (i) a color determined based at least in part on the total accuracy score of the first estimate and (ii) a size determined based at least in part on a number of estimates associated with the first payer system in relation to remaining payer systems of the plurality of payer systems, wherein the payer breakout user interface component is configured to automatically update the plurality of blocks based at least in part on a change in the total accuracy score of the first estimate, and one or more filtering options, wherein a first filtering option enables a user to select a date range; in response to receiving an indication of a user selection of the first block, generate and transmit… updated display instructions that, when executed, cause a first updated user interface element to be displayed… the first updated user interface element comprising: information associated with the first payer system, and at least one of a change in the size or the color of the first block; in response to receiving an indication of a user selection of a first date range, cause a second updated user interface element to be displayed, the second updated user interface element comprising: a subset of the plurality of blocks, wherein a second block of the plurality of blocks associated with the first payer system comprises a number of estimates associated with the first payer system that are generated on dates within the first date range; and receive… a second plurality of estimates that are generated by a second estimation model associated with the service provider system, wherein a second estimate of the second plurality of estimates comprises the plurality of elements of the first estimate, and wherein the second estimation model utilizes a different weighting than the first estimation model for at least one element of the plurality of elements, wherein the different weighting is determined based on the total accuracy score of the first estimate, recites a fundamental economic practice, directed to mitigating risk.
If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation as a fundamental economic practice or commercial or legal interactions, then it falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas. Accordingly, the claim recites an abstract idea.
The “a system”, “at least one processing device”, “at least one computer readable data storage device”, “a service provider system”, “a first estimation model”, “a first data store”, “a first payer system”, “a second data store”, and “a display device”, in claim 21; and the additional technical element of “a non-transitory computer-readable storage device”, “computer readable instructions”, and “a processing unit”, in claim 37, are just applying generic computer components to the recited abstract limitations. The recitation of generic computer components in a claim does not necessarily preclude that claim from reciting an abstract idea. Claims 32 and 37 are also abstract for similar reasons. (Step 2A-Prong 1: YES. The claims recite an abstract idea)
This judicial exception is not integrated into a practical application. In particular, the claims recite the additional elements of: a computer such as a system, a service provider system, a first payer system, and a processing unit; a communication device such as a display device; a storage unit such as at least one computer readable data storage device, a first data store, a second data store, and a non-transitory computer-readable storage device; and software module and algorithm such as a first estimation model, and computer readable instructions. The computer hardware/software is/are recited at a high-level of generality (i.e., as a generic processor performing a generic computer function) such that it amounts no more than mere instructions to apply the exception using a generic computer component. Accordingly, these additional elements, when considered separately and as an ordered combination, do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea and are at a high level of generality. Therefore, claims 21, 32, and 37 are directed to an abstract idea without a practical application. (Step 2A-Prong 2: NO. The additional claimed elements are not integrated into a practical application)
The claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception because, when considered separately and as an ordered combination, they do not add significantly more (also known as an “inventive concept”) to the exception. As discussed above with respect to integration of the abstract idea into a practical application, the additional element of using a computer hardware amounts to no more than mere instructions to apply the exception using a generic computer component. Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. Accordingly, these additional elements, do not change the outcome of the analysis, when considered separately and as an ordered combination. Thus, claims 21, 32, and 37 are not patent eligible. (Step 2B: NO. The claims do not provide significantly more)
Dependent claims further define the abstract idea that is present in their respective independent claims 21, 32, and 37 and thus correspond to Certain Methods of Organizing Human Activity, and hence are abstract for the reasons presented above.
Dependent claim 22 discloses the limitation of based on a total accuracy score for each of the first plurality of estimates, determine an accuracy rate for the first plurality of estimates, which further narrows the abstract idea.
Dependent claim 23 discloses the limitation of compare the accuracy rate for the first plurality of estimates against an estimation accuracy goal value to determine whether the accuracy rate meets the estimation accuracy goal value; and include a visual indication component of the accuracy rate for the first plurality of estimates in comparison with the estimation accuracy goal value in the user interface element, which further narrows the abstract idea.
Dependent claim 24 discloses the limitation of the user interface element comprises instructions for rendering a user interface on a remote user device, which further narrows the abstract idea. Note that the technical element “a remote user device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 25 discloses the limitation of the plurality of elements comprises at least one of: chargemaster amount, contractual adjustment amount, patient benefit amount, or patient responsibility amount, which further narrows the abstract idea.
Dependent claim 26 discloses the limitation of to determine the accuracy score for each of the plurality of elements, the instructions further cause the at least one processing device to: match a charge description master value associated with the first estimate against an actual charge description master value associated with the first remittance; apply scoring criteria; and determine a score for a charge description master value element based on the scoring criteria, which further narrows the abstract idea. Note that the technical element “the at least one processing device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 27 discloses the limitation of to determine the accuracy score for each of the plurality of elements, the instructions further cause the at least one processing device to: match a contractual adjustment value associated with the first estimate against an actual contractual adjustment value associated with the first remittance; apply scoring criteria; and determine a score for a contractual adjustment value element based on the scoring criteria, which further narrows the abstract idea. Note that the technical element “the at least one processing device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 28 discloses the limitation of to determine the accuracy score for each of the plurality of elements, the instructions further cause the at least one processing device to: match a copayment value associated with the first estimate against an actual copayment value associated with the first remittance; apply scoring criteria; and determine a score for a copayment value element based on the scoring criteria, which further narrows the abstract idea. Note that the technical element “the at least one processing device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 29 discloses the limitation of to determine the accuracy score for each of the plurality of elements, the instructions further cause the at least one processing device to: match a deductible value associated with the first estimate against an actual deductible value associated with the first remittance; apply scoring criteria; and determine a score for a deductible value element based on the scoring criteria, which further narrows the abstract idea. Note that the technical element “the at least one processing device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 30 discloses the limitation of to determine the accuracy score for each of the plurality of elements, the instructions further cause the at least one processing device to: match a coinsurance value associated with the first estimate against an actual coinsurance value associated with the first remittance; apply scoring criteria; and determine a score for a coinsurance value element based on the scoring criteria, which further narrows the abstract idea. Note that the technical element “the at least one processing device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 31 discloses the limitation of to determine the accuracy score for each of the plurality of elements associated with the estimate, the instructions further cause the at least one processing device to: match a patient responsibility value associated with the first estimate against an actual patient responsibility value associated with the first remittance; apply scoring criteria; and determine a score for a patient responsibility value element based on the scoring criteria, which further narrows the abstract idea. Note that the technical element “the at least one processing device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 33 discloses the limitation of based on a total accuracy score for each of the first plurality of estimates, determining an accuracy rate for the first plurality of estimates; comparing the accuracy rate for the first plurality of estimates against an estimation accuracy goal value to determine whether the accuracy rate meets the estimation accuracy goal value; and including a visual indication component of the accuracy rate for the first plurality of estimates in comparison with the estimation accuracy goal value in the user interface element, which further narrows the abstract idea.
Dependent claim 34 discloses the limitation of the user interface element comprises instructions for rendering a user interface on a remote user device, which further narrows the abstract idea. Note that the technical element “a remote user device” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 35 discloses the limitation of the plurality of elements comprises at least one of: chargemaster amount, contractual adjustment amount, patient benefit amount, or patient responsibility amount, which further narrows the abstract idea.
Dependent claim 36 discloses the limitation of determining the accuracy score for each of the plurality of elements associated with the estimate comprises: matching a charge description master value associated with the first estimate against an actual charge description master value associated with the first remittance; matching a contractual adjustment value associated with the first estimate against an actual charge description master value associated with the first remittance; matching a copayment value associated with the first estimate against an actual copayment value associated with the first remittance; matching a deductible value associated with the first estimate against an actual copayment value associated with the first remittance; matching a coinsurance value associated with the first estimate against an actual coinsurance value associated with the first remittance; matching a patient responsibility value associated with the first estimate against an actual patient responsibility value associated with the first remittance; applying scoring criteria to the matched values; and determining, based on the scoring criteria: a charge description master value element score; a contractual adjustment value element score; a copayment value element score; a deductible value element score; a coinsurance value element score; and a patient responsibility value element score, which further narrows the abstract idea.
Dependent claim 38 discloses the limitation of the instructions, when executed by the processing unit, are further configured to: based on a total accuracy score for each of the first plurality of estimates, determine an accuracy rate for the first plurality of estimates; compare the accuracy rate for the first plurality of estimates against an estimation accuracy goal value to determine whether the accuracy rate meets the estimation accuracy goal value; and include a visual indication component of the accuracy rate for the first plurality of estimates in comparison with the estimation accuracy goal value in the user interface element, which further narrows the abstract idea. Note that the technical element “the processing unit” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Dependent claim 39 discloses the limitation of the instructions, when executed by the processing unit, are further configured to: determine a number of estimates included in the first plurality of estimates that are associated with the first payer system; determine an amount by which a total of patient responsibility values included in the first plurality of estimates differ from a total of actual patient responsibility values; and include, in the user interface element, a visual indication of: the number of estimates included in the first plurality of estimates that are associated with the first payer system; the amount by which the total of patient responsibility values included in the first plurality of estimates differ from the total of actual patient responsibility values; whether the total of patient responsibility values included in the first plurality of estimates is greater than or less than the total of actual patient responsibility values; and a degree by which the total of patient responsibility values included in the first plurality of estimates is greater than or less than the total of actual patient responsibility values, which further narrows the abstract idea. Note that the technical elements “the processing unit” and “the first payer system” are recited at a high level of generality. They do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea.
Dependent claim 40 discloses the limitation of when executed by the processing unit, are further configured to: match a charge description master value associated with the first estimate against an actual charge description master value associated with the first remittance; match a contractual adjustment value associated with the first estimate against an actual charge description master value associated with the first remittance; match a copayment value associated with the first estimate against an actual copayment value associated with the first remittance; match a deductible value associated with the first estimate against an actual copayment value associated with the first remittance; match a coinsurance value associated with the first estimate against an actual coinsurance value associated with the first remittance; match a patient responsibility value associated with the first estimate against an actual patient responsibility value associated with the first remittance; apply scoring criteria to the matched values; and determine, based on the scoring criteria: a charge description master value element score; a contractual adjustment value element score; a copayment value element score; a deductible value element score; a coinsurance value element score; and a patient responsibility value element score, which further narrows the abstract idea. Note that the technical element “the processing unit” is recited at a high level of generality. It does not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea.
Thus, the dependent claims do not include any additional elements that integrate the abstract idea into a practical application or are sufficient to amount to significantly more than the judicial exception when considered both individually and as an ordered combination. Therefore, the dependent claims are directed to an abstract idea. Thus, the claims 21-40 are not patent-eligible.
Conclusion
The prior art made of record and not relied upon is considered pertinent to applicant’s disclosure.
Jones (20160132646) teaches methods and systems for calculating health care treatment statistics.
Soisson (20200020043) teaches condition-based health care cost estimation.
Adegan (10360601) teaches method for generating a repair estimate through predictive analytics.
Any inquiry concerning this communication or earlier communications from the examiner should be directed to MARK H GAW whose telephone number is (571)270-0268. The examiner can normally be reached Mon-Fri: 9am -5pm.
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If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, Mike Anderson can be reached on 571 270-0508. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
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/MARK H GAW/Examiner, Art Unit 3693