Notice of Pre-AIA or AIA Status
The present application is being examined under the pre-AIA first to invent provisions.
Status of Claims
Claims 1-32 have been examined. Claims 1-2, 4, 10, 15, 18-21, 23, 25, 28, 30, 32 have been amended.
Double Patenting
The nonstatutory double patenting rejection is based on a judicially created doctrine grounded in public policy (a policy reflected in the statute) so as to prevent the unjustified or improper timewise extension of the “right to exclude” granted by a patent and to prevent possible harassment by multiple assignees. A nonstatutory double patenting rejection is appropriate where the conflicting claims are not identical, but at least one examined application claim is not patentably distinct from the reference claim(s) because the examined application claim is either anticipated by, or would have been obvious over, the reference claim(s). See, e.g., In re Berg, 140 F.3d 1428, 46 USPQ2d 1226 (Fed. Cir. 1998); In re Goodman, 11 F.3d 1046, 29 USPQ2d 2010 (Fed. Cir. 1993); In re Longi, 759 F.2d 887, 225 USPQ 645 (Fed. Cir. 1985); In re Van Ornum, 686 F.2d 937, 214 USPQ 761 (CCPA 1982); In re Vogel, 422 F.2d 438, 164 USPQ 619 (CCPA 1970); In re Thorington, 418 F.2d 528, 163 USPQ 644 (CCPA 1969).
A timely filed terminal disclaimer in compliance with 37 CFR 1.321(c) or 1.321(d) may be used to overcome an actual or provisional rejection based on nonstatutory double patenting provided the reference application or patent either is shown to be commonly owned with the examined application, or claims an invention made as a result of activities undertaken within the scope of a joint research agreement. See MPEP § 717.02 for applications subject to examination under the first inventor to file provisions of the AIA as explained in MPEP § 2159. See MPEP § 2146 et seq. for applications not subject to examination under the first inventor to file provisions of the AIA . A terminal disclaimer must be signed in compliance with 37 CFR 1.321(b).
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Claim 1 is rejected on the ground of nonstatutory double patenting as being unpatentable over claim 1 of U.S. Patent No. 10,733,683. Although the claims at issue are not identical, they are not patentably distinct from each other because claim 1 of the current application and claim 1 of US. Patent no. 10,733,683 both recite a first set/second set of member information that describes a member covered by a first/second health plan, comparing a portion of a first/second set, determining both sets related to first/second members, identifying coverages of both members.
Claim 1 is rejected on the ground of nonstatutory double patenting as being unpatentable over claim 1 of U.S. Patent No. 11,416,818. Although the claims at issue are not identical, they are not patentably distinct from each other because claim 1 of the current application and claim 1 of US. Patent no. 11,416,818 both recite a first set/second set of member information that describes a member covered by a first/second health plan, comparing a portion of a first/second set, determining both sets related to first/second members, identifying coverages of both members,
Claims 1, 20, 32 are rejected on the ground of nonstatutory double patenting as being unpatentable over claims 1, 20, 32 of U.S. Patent No. 12,093,894. Although the claims at issue are not identical, they are not patentably distinct from each other because claim 1 of the current application and claim 1 of US. Patent no. 12,093,894 both recite a first set/second set of member information that describes a member covered by a first/second health plan, comparing a portion of a first/second set, determining both sets related to first/second members, identifying coverages of both members. The claims differ in which claims 1, 20, 32 of the current application recites portions of the central coordination of benefits registry to be provided to remote devices, wherein providing the portions comprises generating or updating a local coordination of benefits registry comprising a local copy of the coordination of benefits information, stored at a remote device, whereas claims 1, 20, 32 of US Patent no. 12,093,894 recite causing, by the one or more physical processors, the one or more coordination of benefits records to be provided via a network to a remote device.
Allowable Subject Matter Over the Prior Art
The primary reason for indicating allowability over the prior art is the inclusions of the following limitations in the combination as recited.
Claim is directed towards a computer-implemented method of managing a central coordination of benefits registry to facilitate a coordination of benefits for a plurality of health plans that individually have at least some responsibility to pay for one or more medical expenses for healthcare services received by members covered by more than one health plan, the coordination of benefits being made prior to a request for a payment for the healthcare services;
the method being implemented on a computer that includes one or more physical processors programmed with computer program instructions that, when executed by the one or more physical processors, program the computer to perform the method, the method comprising:
generating, by the one or more physical processors, prior to a request for payment for the healthcare services, one or more coordination of benefits records that indicate that a first member is covered by both a first health plan and a second health plan, wherein the one or more coordination of benefits records have a common data structure, the common data structure comprising: (i) at least a portion of a first coverage information, (ii) at least a portion of a second coverage information, and (iii) a member identifier that identifies a first member;
updating, by the one or physical processors, a central coordination of benefits registry with the one or more coordination of benefits records;
causing, by the one or more physical processors, portions of the central coordination of benefits registry to be provided to remote devices, wherein providing the portions comprises generating or updating a local coordination of benefits registry comprising a local copy of the coordination of benefits information, stored at a remote device.
For claim rejection under 35USC 101, the current invention recites “generating by the one or more physical processors, prior to payment of the one or more Page 2 of 22medical expenses by the first health plan or the second health plan, one or more coordination of benefits records that indicate that the first member is covered by both the first health plan and the second health plan based on the determination, wherein the one or more coordination of benefits records have the common data structure, the common data structure comprising : (i) at least a portion of the first coverage information, (ii) at least a portion of the second coverage information, and (iii) a member identifier that identifies the first member”. Under Patent Subject Matter Eligibility Guidance (MPEP 2106.04-07), the combination of recited additional elements in the recited claims is patent eligible because the claims as a whole integrate an abstract idea into practical application under Prong Two of Step 2A of the Alice/Mayo Test as described in MPEP2106.04-.07. The claims are eligible because it is not directed to an abstract idea or any other judicial exception.
For claim rejection under 35 USC 103, the closest prior art relates to Harris, Sr. et al. (US 8,321,243 hereinafter Harris) in view of Malec et al. (US.20110066446A1 hereinafter Malec). Harris discloses Systems and methods are provided for the coordination of benefits. The systems and methods may include receiving a healthcare claim request from a healthcare provider computer; determining, based at least in part from patient information in the healthcare transaction claim request, that the patient is associated with at least a first payer and a second payer; generating a primary claim request based upon the identified product and the patient associated with the healthcare claim request, the primary claim associated with the first payer; and generating a coordination of benefits (COB) claim request based at least in part on the received first adjudicated reply associated with the primary claim request, the COB claim request, the COB claim request associated with a second payer. Malec discloses providing distributed registration management may include receiving, from a first health system entity, an indication of a healthcare registration event intended to register a patient for an event at a second health system entity in which the patient has a first patient identifier associated with the first health system entity, providing a second patient identifier associated with the second health system entity that correlates to the first patient identifier, and coordinating, via processing circuitry, registration of the second patient identifier for the registration event with the second health system entity.
. However, the combined art fail to teach updating, by the one or physical processors, a central coordination of benefits registry with the one or more coordination of benefits records; causing, by the one or more physical processors, portions of the central coordination of benefits registry to be provided to remote devices, wherein providing the portions comprises generating or updating a local coordination of benefits registry comprising a local copy of the coordination of benefits information, stored at a remote device..
The foreign reference WO 2008133721 A1 discloses Healthcare insurance coverage is determined using an account within a payment processing system. A transmission addressed to the payment processing system is formed including an account number of an account associated with the payment processing system, a description of a healthcare related commodity rendered to a patient deriving healthcare insurance through an insured, and request for a specification of financial responsibility of the insured for the described said healthcare related commodity. A transmission is received from the payment processing system including the requested specification of financial responsibility. discloses Healthcare insurance coverage is determined using an account within a payment processing system. A transmission addressed to the payment processing system is formed including an account number of an account associated with the payment processing system, a description of a healthcare related commodity rendered to a patient deriving healthcare insurance through an insured, and request for a specification of financial responsibility of the insured for the described said healthcare related commodity. A transmission is received from the payment processing system including the requested specification of financial responsibility..
However, the reference does not disclose updating, by the one or physical processors, a central coordination of benefits registry with the one or more coordination of benefits records; causing, by the one or more physical processors, portions of the central coordination of benefits registry to be provided to remote devices, wherein providing the portions comprises generating or updating a local coordination of benefits registry comprising a local copy of the coordination of benefits information, stored at a remote device.
Claims 1-32 would be allowable if rewritten to overcome the rejection(s) under Double Patenting, as set forth in this Office action and to include all of the limitations of the base claim and any intervening claims.
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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/HIEP V NGUYEN/Primary Examiner, Art Unit 3686
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