DETAILED ACTION
Status of Claims
Applicant has amended claims 1, 6-8, 10, 13-15, 17 and 20. No claims have been added or canceled. Thus, claims 1-20 remain pending in this application. The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Response to Arguments
Applicant’s arguments and amendments filed on 20 July 2026 with respect to:
rejections of claims 1, 8 and 15 under U.S.C. § 112(a),
rejections of claims 1-20 under U.S.C. § 112(b),
rejection to claims 1-20 under U.S.C. § 101,
rejections of claims 1, 6-8, 13-15 and 20 under 35 U.S.C. § 103 as being unpatentable over Gore et al (US Patent No. 11,127,082 B1) in view of Luong (US Pub. No. 20210065259 A1), and
rejections of claims 2-5, 9-12 and 16-19 under 35 U.S.C. § 103 as being unpatentable over Gore in view of Luong, in further view of Kusens (US Pub. No. 20210065259 A1)
have been fully considered. Amendments to claims have been entered.
Examiner acknowledges amendments to claims to overcome and 35 U.S.C. § 112(a) and § 112(b) rejections, and 35 U.S.C. § 101 rejections and, in turn, withdraws rejections.
Applicant's arguments filed with respect to claims 1-20 regarding the 35 U.S.C. § 103 rejections have been fully considered but they are moot in view of new ground(s) of rejection.
If, in the opinion of the Applicant, a telephone conference would expedite the prosecution of the subject application, the Applicant is encouraged to contact the undersigned Examiner at the phone number listed below.
Priority
This application was filed on 12 December 2024. Accordingly, this application is given priority from 12 December 2024.
Claim Interpretation
Regarding claims 1, 8 and 15, clauses such as:
the one or more individuals including at least one of an individual previously contacted during the claim process or a new party that provides additional information for the claim process
in representative claim 1 are merely statements of intended use which do not affect the method step of:
determine one or more optimal individuals to resolve the anomaly or information gap.
Similar phrasing will be interpreted accordingly.
A recitation of intended use or purpose of the claimed invention must result in a structural difference between the claimed invention and the prior art in order to patentably distinguish the claimed invention from the prior art. If the prior art structure is capable of performing the intended use or fulfilling said purpose, then it meets the claim.
The subject matter of a properly construed claim is defined by the terms that limit its scope. It is this subject matter that must be examined. As a general matter, the grammar and intended meaning of terms used in a claim will dictate whether the language limits the claim scope. Language that suggests or makes optional but does not require steps to be performed or does not limit a claim to a particular structure does not limit the scope of a claim or claim limitation. The following are examples of language that may raise a question as to the limiting effect of the language in a claim:
(A) statements of intended use or field of use,
(B) "adapted to" or "adapted for" clauses,
(C) "wherein" clauses, or
(D) "whereby" clauses.
This list of examples is not intended to be exhaustive. See also MPEP § 2111.04.
USPTO personnel must consider all claim limitations when determining patentability of an invention over the prior art. In re Gulack, 703 F.2d 1381, 1385, 217 USPQ401, 403-04 (Fed. Cir. 1983). Since a claim must be read as a whole, USPTO personnel may not disregard claim limitations comprised of printed matter. See Gulack, 703F.2d at 1384, 217 USPQ at 403; see also Diamond v. Diehr, 450 U.S. 175, 191, 209 USPQ 1, 10 (1981). However, USPTO personnel need not give patentable weight to printed matter absent a new and unobvious functional relationship between the printed matter and the substrate. See In re Lowry, 32 F.3d 1579, 1583-84, 32 USPQ2d 1031, 1035 (Fed. Cir. 1994); In re Ngai, 367F.3d 1336, 70 USPQ2d 1862 (Fed. Cir. 2004). The rationale behind the printed matter cases, in which, for example, written instructions are added to a known product, has been extended to method claims in which an instructional limitation is added to a method known in the art. Similar to the inquiry for products with printed matter thereon, in such method cases the relevant inquiry is whether a new and unobvious functional relationship with the known method exists. See In re Kao, 639 F.3d1057, ___, 98 USPQ2d 1799, 1811-12 (Fed. Cir. 2011); King Pharmaceuticals Inc. v. Eon Labs Inc., 616 F.3d1267, ___, 95 USPQ2d 1833, 1842 (Fed. Cir. 2010). See MPEP § 2111.05.
Claim Rejections - 35 USC § 103
In the event the determination of the status of the application as subject to AIA 35 U.S.C. 102 and 103 (or as subject to pre-AIA 35 U.S.C. 102 and 103) is incorrect, any correction of the statutory basis for the rejection will not be considered a new ground of rejection if the prior art relied upon, and the rationale supporting the rejection, would be the same under either status.
The following is a quotation of 35 U.S.C. 103 which forms the basis for all obviousness rejections set forth in this Office action:
A patent for a claimed invention may not be obtained, notwithstanding that the claimed invention is not identically disclosed as set forth in section 102, if the differences between the claimed invention and the prior art are such that the claimed invention as a whole would have been obvious before the effective filing date of the claimed invention to a person having ordinary skill in the art to which the claimed invention pertains. Patentability shall not be negated by the manner in which the invention was made.
Claims 1, 6-8, 13-15 and 20 are rejected under 35 U.S.C. 103 as being unpatentable over Gore et al (US Patent No. 11,127,082 B1) in view of Shah et al (US Pub. No. 20230282358 A1).
Regarding claims 1, 8 and 15, Gore teaches methods, computer-readable media, and apparatuses for automating the determining whether claims related to an insured item should proceed to an arbitrating body [col. 1 lines 60-65]. He teaches:
a network communication interface; one or more processors; and a memory storing instructions that, when executed by the one or more processors – [col. 3 lines 8-44], [Fig. 2], cause the computing system to:
based on information provided by one or more parties connected to a claim process, perform an automated investigative process on a claim corpus corresponding to the claim process – [col. 2 lines 13-19];
based on the automated investigative process, identify at least one of an anomaly or information gap within the claim corpus - [col. 2 line 60-col. 3 line 7] “identify missing information useful in determining whether the claim should proceed to arbitration”, [col. 4 line 45-col. 5 line 2] “identifying and obtaining missing information relevant to fault determinations”;
determine one or more individuals to resolve the anomaly or information gap – [col. 4 line 45-col. 5 line 2] “network devices 201 may represent mobile user devices of other insurance representatives (e.g., other insurance claims adjusters), [col. 6 line 53-col. 7 line 3] “a computing device (e.g., computer, laptop, tablet computer, mobile phone, etc.) may be responsible for managing and assisting an insurance representative (e.g., an insurance adjuster, subrogation representative, etc.)”, the one or more individuals including at least one of an individual previously contacted during the claim process or a new party that provides additional information for the claim process – not further limiting; and
execute a voice-AI engine and adaptive flow engine to perform a voice-AI session with each of the one or more optimal individuals to resolve the anomaly or information gap – [col. 5 lines 3-43].
Gore does not explicitly disclose:
execute a voice-AI engine and adaptive flow engine to perform a voice-AI session with each of the one or more optimal individuals to resolve the anomaly or information gap,the adaptive flow engine comprising one or more machine-learning models trained using a corpus of historical claim data, wherein executing the voice-AI engine includes:
during the voice-AI session, generating, by the adaptive flow engine, a real-time conversation flow for dynamic scripting by the voice-AI engine, the real-time conversation flow being generated to obtain information that resolves the at least one of the anomaly or information gap; and
conversing, through execution of the voice-AI engine, with a computing device of each of the one or more individuals during the voice-AI session by responding to vocal outputs of the individual using responses generated by the adaptive flow engine and converted into voice output by the voice-AI engine.
However, Shah teaches a computing system which allows a user to access health records via an executing application on the user’s computing device or via website through a browser [0019]. He teaches a computing system implementing automatic health record compiling, code translation, and dynamic scripting for call agents in connection with a health service [0008]-[0010], [0012], [Fig. 5A], [Fig. 5B], [Fig. 6] and [Fig. 8A]-[Fig. 8D]. He teaches the computing system initiating a dispute process to reconcile a disputed record and to resolve a discrepancy [0025]. He teaches a dynamic scripting interface and scripting logic executing voice-to-text logic [0041]. He teaches providing dynamic scripting during call sessions [0044]. He teaches implementing machine learning and/or artificial intelligence to execute described processes [0065] and implementing these processes using programmatic modules and engines [0066].
Therefore, it would have been obvious to one having ordinary skill in the art before the effective filing date of the claimed invention to modify Gore’s disclosure to include dynamic scripting for call agents to resolve record discrepancies as taught by Shah because it is useful in extensive information gathering and verification of personal health and medical history information for determining an optimal health care plan for a user - Shah [0003].
Regarding claims 6, 13 and 20, Gore does not explicitly disclose the adaptive flow engine as communicating with each individual of the one or more individuals using a customized communication strategy generated for the individual.
However, Shah teaches that the dynamic scripting engine can execute call monitoring logic to programmatically monitor the interactions between the call agent and the user, and adapt the dynamic scripting accordingly [0093].
Therefore, it would have been obvious to one having ordinary skill in the art before the effective filing date of the claimed invention to modify Gore’s disclosure to include adapting the dynamic scripting for interactions between call agents and users as taught by Shah because one would have recognized that such ability improves the system and makes the system cost effective.
Regarding claims 7 and 14, Gore does not explicitly disclose the adaptive flow engine as generating the customized communication strategy based on engagement data obtained from the individual in one or more previous communication sessions.
However, Shah teaches one or more health planning sessions to provide customized lifestyle recommendations that would mitigate or reduce the current and predicted health risks of the user [0093].
Therefore, it would have been obvious to one having ordinary skill in the art before the effective filing date of the claimed invention to modify Gore’s disclosure to include customized lifestyle recommendations as taught by Shah because one would have recognized that such ability improves the system and makes the system cost effective.
Claims 2-5, 9-12 and 16-19 are rejected under 35 U.S.C. 103 as being unpatentable over Gore in view of Shah, in further view of Kusens (US Pub. No. 20210065259 A1).
Regarding claims 2, 9 and 16, neither Gore nor Shah explicitly discloses the anomaly as comprising conflicting information in the claim corpus.
However, Kusens teaches systems and methods for identifying possible third-party liability for healthcare costs [0002]. He teaches matching liability claims such as legal or liability insurance claims, [0079]. He teaches a method for anomaly spotting by identifying gaps in information, conflicting information, impossible/improbable information, etc. [0101].
Therefore, it would have been obvious to one having ordinary skill in the art before the effective filing date of the claimed invention to modify Gore’s disclosure to include identifying conflicting information when processing liability claims as taught by Kusens because it simplifies the process for identifying and billing third party payer/obligors, to provide additional revenue for healthcare providers and save Medicare the unnecessary costs of recovering payment from third parties - Kusens [0004].
Regarding claims 3, 10 and 17, Gore does not explicitly disclose the voice-AI engine as performing the voice-AI session with each of the one or more individuals to corroborate information that resolves the anomaly.
However, Shah teaches initiating a dispute process to reconcile a disputed record and to resolve a discrepancy [0025] as discussed in the rejection of claim 1. Accordingly, this claim is rejected for the same reasons.
Regarding claims 4, 11 and 18, Gore teaches updating a claim file corresponding to the claim corpus to indicate the resolved anomaly – [col. 15, lines 33-37].
Regarding claims 5, 12 and 19, Gore teaches updating the claim file to include a fraud score for an individual responsible for the conflicting information – [col. 6 lines 20-32].
Conclusion
The prior art of record and not relied upon is considered pertinent to Applicant’s disclosure:
Wilde et al: “METHOD AND SYSTEM FOR NAVIGATING AT A CLIENT DEVICE SELECTED FEATURES ON A NON-DYNAMIC IMAGE PAGE FROM AN ELASTIC VOICE CLOUD SERVER IN COMMUNICATION WITH A THIRD-PARTY SEARCH SERVICE”, (US Pub. No. 20210099768 A1).
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.
Any inquiry concerning this communication or earlier communications from the examiner should be directed to EDWARD J BAIRD whose telephone number is (571)270-3330. The examiner can normally be reached 7 am to 3:30 pm M-F.
Examiner interviews are available via telephone, in-person, and video conferencing using a USPTO supplied web-based collaboration tool. To schedule an interview, applicant is encouraged to use the USPTO Automated Interview Request (AIR) at
http://www.uspto.gov/interviewpractice.
If Applicant wishes to correspond to the Examiner via email, Applicant needs to file an AUTHORIZATION FOR INTERNET COMMUNICATIONS IN A PATENT APPLICATION form. The form may be downloaded at:
https://www.uspto.gov/sites/default/files/documents/sb0439.pdf
If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, Ryan Donlon can be reached at 571-270-3602. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
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/EDWARD J BAIRD/Primary Examiner, Art Unit 3692
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