DETAILED ACTION
Notice of Pre-AIA or AIA Status
1. 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 Amendment
2. The Amendment filed on April 02, 2026 has been entered. Claims 1 and 19 have been amended. Claims 15 and 17 have been cancelled. Claims 21 and 22 have been newly added. Thus, claims 1-14, 16, and 18-22 are pending and rejected for the reasons set forth below.
Claim Rejections - 35 USC § 101
3. 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.
4. Claims 1-14, 16, and 18-22 are rejected under 35 U.S.C. § 101 because the claimed invention is directed to a judicial exception (i.e., a law of nature, a natural phenomenon, or an abstract idea) without significantly more.
In sum, claims 1-14, 16, and 18-22 are rejected under 35 U.S.C. §101 because the claimed invention is directed to a judicial exception to patentability (i.e., a law of nature, a natural phenomenon, or an abstract idea) and do not include an inventive concept that is something “significantly more” than the judicial exception under the January 2019 patentable subject matter eligibility guidance (2019 PEG) analysis which follows.
Under the 2019 PEG step 1 analysis, it must first be determined whether the claims are directed to one of the four statutory categories of invention (i.e., process, machine, manufacture, or composition of matter). Applying step 1 of the analysis for patentable subject matter to the claims, it is determined that the claims are directed to the statutory category of a machine (claims 1-14, 16, 18, and 21-22) and a system (claims 19-20). Therefore, we proceed to step 2A, Prong 1.
Under the 2019 PEG step 2A, Prong 1 analysis, it must be determined whether the claims recite an abstract idea that falls within one or more designated categories of patent ineligible subject matter (i.e., organizing human activity, mathematical concepts, and mental processes) that amount to a judicial exception to patentability. Here, the claims recite the abstract idea of receiving insurance claim data in order to create an insurance appeal letter by;
providing,…,
the,…,having a medical database storing disease state categorizations, insurance payor requirements, and regulations in a standardized format, the data input module in communication with the reactive,…,,
the user interface,…,permitting interaction with the system,…, by the user, the user interface,…,in communication with the letter generation,…,and the machine learning,…, and
the letter generation,…,configured to generate a first appeal letter and a second appeal letter, the letter generating,…,configured for permitting for interaction with the first appeal letter and the second appeal letter via the user interface, the letter generation,…,in communication with the reactive AI,…, and the machine learning,…,;
providing the denied insurance claim to the data input,…, of the,…, and in a non-standardized format dependent on an insurance company;;
providing a patient history record to the data input,…,of the,…, and being in a non-standardized format;
normalizing, by the data input,…,, the denied insurance claim and the patient history record by converting the non-standardized denied insurance claim and the non-standardized patient history record into standardized claim data by scrubbing for claim data related to the denied insurance claim and the patient history record;
comparing, by the reactive AI, the standardized claim data to the medical database to identify applicable disease state categorizations, insurance payor requirements specific to the insurance company, and regulations;
generating, by the reactive AI ,…, a letter recommendation based on the identified applicable disease state categorizations, insurance payor requirements specific to the insurance company, and regulations medical database of the data input module;
generating, by the letter generation,…,, the first appeal letter based on the standardized claim data, the medical database, and the letter recommendation, wherein the first appeal letter is customized to the insurance company based on the insurance payor requirements specific to the insurance company;
presenting, by the user interface, the first appeal letter to the user for review;
reviewing, by the user, the first appeal letter to generate an editing parameter based on a criteria of the insurance company for approved insurance claims;
storing, by the machine learning module, the editing parameter generated by the user to the first appeal letter to learn insurance company-specific criteria for a successful appeal;
updating the machine learning,…, based on the editing parameter generated by the user to the first appeal letter; and
generating, by the letter generation,…, the second appeal letter based on the update to the,…, wherein the second appeal letter incorporates the learned insurance company-specific criteria.
Here, the recited abstract idea falls within one or more of the three enumerated 2019 PEG categories of patent ineligible subject matter, to wit: certain methods of organizing human activity, which includes fundamental economic practices or principles as well as commercial or legal interactions (e.g., receiving insurance claim data in order to create an insurance appeal letter), in the field of insurance.
Under the 2019 PEG step 2A, Prong 2 analysis, the identified abstract idea to which the claim is directed does not include limitations that integrate the abstract idea into a practical application, since the recited features of the abstract idea are being applied on a computer or computing device or via software programming that is simply being used as a tool (“apply it”) to implement the abstract idea. (See, e.g., MPEP §2106.05(f)). Therefore, the claim is directed to an abstract idea.
Under the 2019 PEG step 2B analysis, the additional elements are evaluated to determine whether they amount to something “significantly more” than the recited abstract idea. (i.e., an innovative concept). Here, the additional elements, such as: a “processor,” “module,” “server,” and “memory” do not amount to an innovative concept since, as stated above in the step 2A, Prong 2 analysis, the claims are simply using the additional elements as a tool to carry out the abstract idea (i.e., “apply it”) on a computer or computing device and/or via software programming. (See, e.g., MPEP §2106.05(f)). The additional elements are specified at a high level of generality to simply implement the abstract idea and are not themselves being technologically improved. (See, e.g., MPEP §2106.05 I.A.); (see also, paragraphs [0035] of the specification). Claim 19 is nearly identical to claim 1 so the same analysis applies to that claim as well.
Dependent claims 2–18 and 20 have been considered and do not integrate the abstract idea into a practical application. Dependent claims 2 and 20 recite limitations that further define the abstract idea noted in claim 1 in that they describe tracking the second appeal letter to see if it results in an approved insurance claim. Dependent claim 3 recites limitations that further define the abstract idea noted in claim 1 in that it describes augmenting the denied insurance claim and the patient history record using a clinical definition. Dependent claim 4 recites limitations that further define the abstract idea noted in claim 1 in that it describes using a language prompt and IP-defined definition for creating the appeal letter. Dependent claim 5 recites limitations that further define the abstract idea noted in claim 1 in that it describes what the patient history includes. Dependent claim 6 recites limitations that further define the abstract idea noted in claim 1 in that it describes comparing claim data against the medical database. Dependent claim 7 recites limitations that further define the abstract idea noted in claim 1 in that it describes scoring the second appeal letter based on a scale. Dependent claim 8 recites limitations that further define the abstract idea noted in claim 1 in that it describes that the reactive AI module includes a combination of training, and model and machine AI. Dependent claim 9 recites limitations that further define the abstract idea noted in claim 1 in that it describes that the data input module includes a change data capture. Dependent claim 10 recites limitations that further define the abstract idea noted in claim 1 in that it describes a step of employing at least several specific machine learning techniques. Dependent claim 11 recites limitations that further define the abstract idea noted in claim 1 in that it describes that the step of comparing the claim data includes a step of evaluating network status. Dependent claim 12 recites limitations that further define the abstract idea noted in claim 1 in that it describes updating the medical database based on categorization of disease states. Dependent claim 13 recites limitations that further define the abstract idea noted in claim 1 in that it describes intaking the patient history record. Dependent claim 14 recites limitations that further define the abstract idea noted in claim 1 in that it describes evaluating a coverage limit. Dependent claim 15 recites limitations that further define the abstract idea noted in claim 1 in that it describes storing the data at a third level of normalization. Dependent claim 16 recites limitations that further define the abstract idea noted in claim 1 in that it describes training the reactive AI module through reviewing the editing parameter. Dependent claim 17 recites limitations that further define the abstract idea noted in claim 1 in that it describes suggesting another related medical condition to the denied insurance claim. Dependent claim 18 recites limitations that further define the abstract idea noted in claim 1 in that it describes that editing the parameter includes incorporating an approved insurance claim criteria. Dependent claim 21 recites limitations that further define the abstract idea noted in claim 1 in that it describes that the step of normalizing includes converting scanned documents to a specific machine readable format using a generic means. Dependent claim 22 recites limitations that further define the abstract idea noted in claim 1 in that it describes that the letter generation module manages letter templates for generating the first appeal letter and the second appeal letter.
The additional elements of the dependent claims merely refine and further limit the abstract idea of the independent claims and do not add any feature that is an “inventive concept” which cures the deficiencies of their respective parent claim under the 2019 PEG analysis. None of the dependent claims considered individually, including their respective limitations, include an “inventive concept” of some additional element or combination of elements sufficient to ensure that the claims in practice amount to something “significantly more” than patent-ineligible subject matter to which the claims are directed.
The elements of the instant process steps when taken in combination 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 because the claims do not effect an improvement to another technology or technical field (e.g., the field of computer coding technology is not being improved); the claims do not amount to an improvement to the functioning of an electronic device itself which implements the abstract idea (e.g., the general purpose computer and/or the computer system which implements the process are not made more efficient or technologically improved); the claims do not perform a transformation or reduction of a particular article to a different state or thing (i.e., the claims do not use the abstract idea in the claimed process to bring about a physical change. See, e.g., Diamond v. Diehr, 450 U.S. 175 (1981), where a physical change, and thus patentability, was imparted by the claimed process; contrast, Parker v. Flook, 437 U.S. 584 (1978), where a physical change, and thus patentability, was not imparted by the claimed process); and the claims do not move beyond a general link of the use of the abstract idea to a particular technological environment (e.g., simply claiming the use of a computer and/or computer system to implement the abstract idea).
Prior Art Not Relied Upon
5. The prior art made of record and not relied upon is considered pertinent to applicant’s disclosure. (See, MPEP §707.05). The examiner considers the following reference(s) pertinent for disclosing various features relevant to the invention, but not all the features of the invention, for at least the following reasons:
Mandal et al. (U.S. Pub. No. 2023/0142392) teaches a system artificial intelligence-based decision management system for appeals on healthcare claim. This system receives appeals relating to insurance claims. It then uses the data from the appeal to predict whether or not the appeal will be successful. This differs from the current invention which has to do with generating an appeal from claim denial data submitted by a patient in order to draft a successful appeal.
Response to Arguments
6. Applicant’s arguments filed on April 02, 2026 have been fully considered.
Applicant’s arguments concerning the 35 U.S.C. §101 rejection of the claims, including supposed deficiencies in the rejection, are not persuasive. Applicant argues that “[t]he claims are accordingly patent eligible under 35 U.S.C. § 101 as the claims are not directed to the abstract idea of organizing human activity and instead are directed to normalizing non-standard data and converting it to standardized formats that can be customized to specific insurance companies.” (See Applicant’s Arguments, p. 12). This invention is tied to generating appeals letters regarding a denial of a health insurance claim from an insurance company. Without this, there is no other aspect to the invention, let it be normalization of data or other aspects such as comparing data. Thus, the claims do recite an abstract idea that falls within one or more of the three enumerated 2019 PEG categories of patent ineligible subject matter, to wit: certain methods of organizing human activity, which includes fundamental economic practices or principles as well as commercial or legal interactions (e.g., receiving insurance claim data in order to create an insurance appeal letter), in the field of insurance.
Applicant asserts that “Even if it is maintained that the claims recite an abstract idea at Step 2A, prong 1, Applicant respectfully submits that the claims integrate any such abstract idea into a practical application under Step 2A, prong 2, as discussed below.” (See Applicant’s Arguments, p. 12). However, the amended claim limitations are not indicative of an integration into a practical application as improvement to the functioning of a computer or to any other technology or technical field is not evidenced. Merely using normalization of data does not integrate the abstract idea into a practical application. The conversion of data from one format to another in this invention is not the same as the Example 42 to which Applicant cites as evidence of patent subject matter eligibility. Applicant does not even state what exactly these formats are. There are also no interactive elements that are a part of this invention.
Applicant finally argues that “…Applicant respectfully
submits that Claims 1 and 19 recite additional elements that amount to significantly more than an abstract idea under Step 2B of the framework.” (See Applicant’s Arguments, p. 15). However, providing a specific process to address insurance companies and their denial letters is not a technological improvement. It is merely gathering data and then using various “insurance company requirements” to guide the creation of an appeal letter.
Therefore, the rejection under 35 U.S.C. §101 is maintained.
Conclusion
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 Amit Patel whose telephone number is (313) 446-4902. The Examiner can normally be reached Mon - Thu 8 AM - 6 PM EST. If attempts to reach the Examiner by telephone are unsuccessful, the Examiner’s supervisor, Matthew Gart, can be reached at (571) 272-3955. The Examiner’s fax number is (571) 273-6087. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
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.
Information regarding the status of an application may be obtained from the Patent Center system (https://patentcenter.uspto.gov). If you would like assistance from a USPTO Customer Service Representative or access to the automated information system, call (800) 786-9199 (USA or CANADA) or (571) 272-1000.
/Amit Patel/
Examiner
Art Unit 3696
/EDWARD CHANG/Primary Examiner, Art Unit 3696 04/18/2026
Prosecution Insights