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 .
Priority
Applicant’s claim for the benefit of a prior-filed applications, 18/451,024 filed 08/16/2023, 16/890,956 filed 06/02/2020, 14/845,170 filed 09/03/2015, and 60/048,157 filed 09/09/2014 under 35 U.S.C. 119(e) or under 35 U.S.C. 120, 121, 365(c), or 386(c) is acknowledged.
Claim Interpretation
The following is a quotation of 35 U.S.C. 112(f):
(f) Element in Claim for a Combination. – An element in a claim for a combination may be expressed as a means or step for performing a specified function without the recital of structure, material, or acts in support thereof, and such claim shall be construed to cover the corresponding structure, material, or acts described in the specification and equivalents thereof.
The following is a quotation of pre-AIA 35 U.S.C. 112, sixth paragraph:
An element in a claim for a combination may be expressed as a means or step for performing a specified function without the recital of structure, material, or acts in support thereof, and such claim shall be construed to cover the corresponding structure, material, or acts described in the specification and equivalents thereof.
The claims in this application are given their broadest reasonable interpretation using the plain meaning of the claim language in light of the specification as it would be understood by one of ordinary skill in the art. The broadest reasonable interpretation of a claim element (also commonly referred to as a claim limitation) is limited by the description in the specification when 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, is invoked.
As explained in MPEP § 2181, subsection I, claim limitations that meet the following three-prong test will be interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph:
(A) the claim limitation uses the term “means” or “step” or a term used as a substitute for “means” that is a generic placeholder (also called a nonce term or a non-structural term having no specific structural meaning) for performing the claimed function;
(B) the term “means” or “step” or the generic placeholder is modified by functional language, typically, but not always linked by the transition word “for” (e.g., “means for”) or another linking word or phrase, such as “configured to” or “so that”; and
(C) the term “means” or “step” or the generic placeholder is not modified by sufficient structure, material, or acts for performing the claimed function.
Use of the word “means” (or “step”) in a claim with functional language creates a rebuttable presumption that the claim limitation is to be treated in accordance with 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph. The presumption that the claim limitation is interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, is rebutted when the claim limitation recites sufficient structure, material, or acts to entirely perform the recited function.
Absence of the word “means” (or “step”) in a claim creates a rebuttable presumption that the claim limitation is not to be treated in accordance with 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph. The presumption that the claim limitation is not interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, is rebutted when the claim limitation recites function without reciting sufficient structure, material or acts to entirely perform the recited function.
Claim limitations in this application that use the word “means” (or “step”) are being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, except as otherwise indicated in an Office action. Conversely, claim limitations in this application that do not use the word “means” (or “step”) are not being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, except as otherwise indicated in an Office action.
This application includes one or more claim limitations that do not use the word “means,” but are nonetheless being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, because the claim limitation(s) uses a generic placeholder that is coupled with functional language without reciting sufficient structure to perform the recited function and the generic placeholder is not preceded by a structural modifier. Such claim limitation(s) is/are: “an inventory management module configured to manage” in claim 13.
Because this/these claim limitation(s) is/are being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, it/they is/are being interpreted to cover the corresponding structure described in the specification as performing the claimed function, and equivalents thereof.
If applicant does not intend to have this/these limitation(s) interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, applicant may: (1) amend the claim limitation(s) to avoid it/them being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph (e.g., by reciting sufficient structure to perform the claimed function); or (2) present a sufficient showing that the claim limitation(s) recite(s) sufficient structure to perform the claimed function so as to avoid it/them being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph.
Claim Rejections - 35 USC § 112
The following is a quotation of 35 U.S.C. 112(b):
(b) CONCLUSION.—The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the inventor or a joint inventor regards as the invention.
The following is a quotation of 35 U.S.C. 112 (pre-AIA ), second paragraph:
The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the applicant regards as his invention.
Claims 3 and 12 is rejected under 35 U.S.C. 112(b) or 35 U.S.C. 112 (pre-AIA ), second paragraph, as being indefinite for failing to particularly point out and distinctly claim the subject matter which the inventor or a joint inventor (or for applications subject to pre-AIA 35 U.S.C. 112, the applicant), regards as the invention.
Claim 3 recites “the catalog database.” There is no previous recitation of a “catalog database” in claim 3 or claim 1. Therefore, this limitation lacks sufficient antecedent basis in the claims.
Claim 12 ends with the word “and” and no period. It appears that claim 12 is incomplete, missing limitations to complete the claim. Without the claim being complete, the scope is unclear and indefinite.
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 1-20 are rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more.
Step 2A Prong One
Claims 1 recites receiving from a consumer an order for a health care service bundle associated with a standardized health care service bundle identifier; responsive to receiving the order, transmitting to a provider order information identifying the health care service bundle; and receiving from the provider a fulfillment notification indicating the health care service bundle has been provided to a user; responsive to receiving the fulfillment notification: transmitting payment data f to a financial institution; generating and transmitting receipt documentation in a first format to the consumer; and transmitting claim data in a second format different from the first format to a third-party for adjudication and posting to a patient file.
Claim 8 recites a data management module comprising: a plurality of standardized health care service bundle identifiers, each standardized health care service bundle identifier associated with a defined set of health care services; and health care claims data, receive, from a consumer, an order for a health care service bundle associated with a standardized health care service bundle identifier; transmit, to a provider, order information associated with the order identifying the health care service bundle; receive, from the provider, a fulfillment notification indicating the health care service bundle has been provided; responsive to receiving the fulfillment notification: generate receipt documentation based on the order information; transmit the receipt documentation in a first format to the consumer; and transmit claim data in a second format to a third-party administrator.
Claim 15 recites receive, from a consumer, an order for a health care service bundle, wherein the health care service bundle is associated with a standardized health care service bundle identifier; transmit order information to a provider; receive, from the provider, a fulfillment notification comprising a single order data structure indicating the health care service bundle has been provided; and responsive to receiving the fulfillment notification, automatically generate two different data structures based on the single order data structure, the two different data structures including receipt documentation in a first format and claim data in a second format.
These limitations, as drafted, given the broadest reasonable interpretation, encompass managing interactions between people, which is a subgrouping of Certain Methods of Organizing Human Activity. For example, the claims encompass communications between a consumer, a provider, a financial institution, and a third-party administrator regarding an order for a health care service bundle, fulfillment of the bundle, payment for the order, order receipt, and claim data. In addition to these limitations encompassing interactions between people, they also encompass fundamental economic practices related to requesting and providing services and processing payment and insurance information. Additionally, creating information, including a receipt and a claim, in different formats, encompasses an operation than could be manually carried out by an individual. For example, one of the individuals could manually fill out a claim and manually write a service receipt with pen and paper.
Claims 2-7, 9-14, and 16-20 incorporate the abstract idea identified above and recite additional limitations that expand on the abstract idea. For example, claims 2 and 4 further expand on the receipt documentation. Claims 3 and 5 further expand on the healthcare service bundle. Claims 6, 9, and 16 further expand on communicating and processing claim data. Claims 7, 12, 18, and 20 further include recitations of communicating and processing eligibility information, which further encompasses managing interactions between people, and fundamental economic practices. Claims 10-11, and 17 further expand on the different information for different documents. Claim 13 further includes a fee schedule for a provider, which is a fundamental economic practice. Claims 14 and 19 further recite calculating out-of-pocket cost, which is a fundamental economic practice. As explained above, these manual steps encompass Certain Methods of Organizing Human Activity.
Step 2A Prong Two
This judicial exception is not integrated into a practical application because the remaining elements amount to no more than general purpose computer components programmed to perform the abstract ideas along with insignificant, extra-solution data gathering and transmitting activities.
Claims 8-20, directly or indirectly, recite the following additional elements at a high level of generality and merely utilized as tools to implement the abstract idea:
Claims 8:
a processor; and an external database configured to store healthcare claims data, and memory storing processor-executable instructions that cause the processor.
Claims 9, 12, 14:
the memory further stores processor-executable instructions that cause the processor.
Claim 13:
an inventory management module configured to manage.
Claim 15:
A non-transitory computer-readable storage medium including an executable program stored thereon, the program configured to cause a computer processor.
Claims 16-20:
The non-transitory computer-readable storage medium of claim 15.
The written description discloses that the recited computer components encompass generic components including “each computing device in health care system 100 may take the form of one or more personal computers, server computers, tablet computers, home entertainment computers, network computing devices, mobile computing devices, mobile communication devices, and/or other computing devices” (see paragraph 0022). As set forth in the MPEP 2106.04(d) “merely including instructions to implement an abstract idea on a computer” is an example of when an abstract idea has not been integrated into a practical application.
Claims 1-20, directly or indirectly, recite the following additional elements at a high level of generality, involving no more that extra-solution data gathering and transmitting activity:
Claim 1:
receiving, at the e-commerce platform from a consumer computing device.
transmitting, from the e-commerce platform to a provider computing device.
receiving, at the e-commerce platform from the provider computing device.
transmitting data from the e-commerce platform to a financial institution computing device.
transmitting receipt documentation to the consumer computing device.
transmitting data to a third-party administrator computing device.
Claim 6:
transmitting the data to an electronic data interchange (EDI) system of the third-party administrator computing device.
Claim 7:
Receiving, from the third-party administrator computing device.
Claim 8:
receive, from a consumer computing device.
transmit, to a provider computing device.
receive, from the provider computing device.
transmit to the consumer computing device.
transmit to a third-party administrator computing device.
Claim 12:
transmit to the third-party administrator computing device.
receiving from the third-party administrator computing device.
Claim 14:
displaying via the consumer computing device.
Claim 15:
receive, from a consumer computing device.
transmit to a provider computing device.
receive, from the provider computing device.
Claim 18:
transmit to a third-party administrator computing device via an electronic data interchange (EDI) system.
receive from the third-party administrator computing device.
These additional elements of generic computer components receiving and transmitting information are recited at a high degree of generality and are merely involved in insignificant extra solution data gathering and transmitting of data. As set forth in MPEP 2106.05(g) insignificant, extra-solution activity, such as insignificant acquisition and data transmission, is an example of when an abstract idea has not been integrated into a practical application.
Step 2B
The claim(s) does/do not include additional elements that are sufficient to amount to significantly more than the judicial exception because as discussed above with respect to integration into a practical application, the additional elements are recited at a high level of generality, and the written description indicates that these elements are generic computer components. Using generic computer components to perform abstract ideas does not provide a necessary inventive concept. See Alice, 573 U.S. at 223 (“mere recitation of a generic computer cannot transform a patent-ineligible abstract idea into a patent-eligible invention.”).
Insignificant, extra solution, data gathering activity (e.g. transmitting and receiving data over a computer network) has been found to not amount to significantly more than an abstract idea (see MPEP 2106.05(g) and Electric Power Group, LLC v. Alstom S.A., 830 F.3d 1350, 1354-55, 119 USPQ2d 1739, 1742 (Fed. Cir. 2016)).
Storing and retrieving information in memory has been recognized as well-understood, routine, and conventional activity of a general-purpose computer (see MPEP 2106.05(d) and Versata Dev. Group, Inc. v. SAP Am., Inc., 793 F.3d 1306, 1334, 115 USPQ2d 1681, 1701 (Fed. Cir. 2015); OIP Techs., 788 F.3d at 1363, 115 USPQ2d at 1092-93).
Additionally, the aforementioned additional elements, considered in combination, do not provide an improvement to a technical field or provide a technical improvement to a technical problem. These additional elements merely carry out the abstract idea through data collection, data processing, data communication, and data storage. Therefore, whether considered alone or in combination, the additional elements do not amount to significantly more than the abstract idea.
S
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 (i.e., changing from AIA to pre-AIA ) 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.
Claim(s) 1-20 is/are rejected under 35 U.S.C. 103 as being unpatentable over Schultz, US Patent Application Publication No. 2005/0065819 in view of Beck, US Patent Application Publication No. 2007/0033070.
As per claim 1, Schultz teaches a method for managing health care service transactions in an e-commerce platform, comprising: receiving, at the e-commerce platform from a consumer computing device, an order for a health care service (see paragraphs 0008 and 0021; patient and services to be provided are entered and received at third party payor system (part of an e-commerce platform). When entered with the patient card, data entry device being considered as a consumer computing device); responsive to receiving the order, transmitting, from the e-commerce platform to a provider computing device, order information identifying the health care service (see paragraph 0021; medical service provider system displays patient eligibility for reimbursement for the health care service); and receiving, at the e-commerce platform from the provider computing device, a fulfillment notification indicating the health care service bundle has been provided to a user (see paragraph 0022; medical services provided to patient are entered into the medical service provider system); responsive to receiving the fulfillment notification: transmitting payment data from the e-commerce platform to a financial institution computing device (see paragraph 0022; upon completion of services, fees for the medical services are transferred from electronically accessible source of funds of the payor system to electronically accessible account of the provider system); generating and transmitting receipt documentation in a first format to the consumer computing device (see paragraph 0022; a report (having a first format) is transmitted to the above noted consumer computing device); and transmitting data to a third-party administrator computing device for adjudication and posting to a patient file (see paragraph 0022; data is transmitted to third party payor for adjudication (e.g. determining co-pays or other fees) and can be posted to a patient file for tracking services provided).
Schultz does not explicitly teach the health care services service is a bundle associated with a standardized health care service bundle identifier and transmitting the healthcare service bundle. Schultz also does not explicitly teach transmitting claim data in a second format different from the first format. Beck teaches bundled health care services associated with a standardized health care service bundle identifier and transmitting the healthcare service bundle (see paragraphs 0047 and 0060; provides bundled services associated with an appropriate code) and transmitting claim data in a second format different from a first format (see paragraphs 0026 and 0054; complete claim is transmitted to payer for adjudication, differing in format from EOBs). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to provide the bundled services and claim transmitting of Beck within the medical services processing system of Schultz with the motivation of more accurately managing patient financial responsibilities for multiple medical services (see paragraph 0047 of Beck).
As per claim 2, Schultz and Beck teaches the method of claim 1 as described above. Schultz further teaches generating the receipt documentation comprises information regarding the fulfilled order (see paragraph 0022; report regarding the provided medical services).
As per claim 3, Schultz and Beck teaches the method of claim 1 as described above. Schultz further teaches the standardized health care service identifier is stored in the catalog database and is associated with a defined set of Current Procedural Technology (CPT) codes (see paragraph 0016; medical services identified by CPT code). As noted above, Schultz does not explicitly teach the healthcare service being bundled. Beck teaches bundled healthcare services (see paragraphs 0047 and 0060; provides bundled services associated with an appropriate code). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 1.
As per claim 4, Schultz and Beck teaches the method of claim 1 as described above. Schultz does not explicitly teach the receipt documentation in the first format includes a non-technical description of services provided, and wherein the claim data in the second format includes a technical description comprising a plurality of CPT codes. Beck further teaches the receipt documentation in the first format includes a non-technical description of services provided, and wherein the claim data in the second format includes a technical description comprising a plurality of CPT codes (see paragraph 0051; the determination is explained to the patient by the EOB; paragraph 0048; bundled services for which claims are submitted, represented by CPT codes). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 1.
As per claim 5, Schultz and Beck teaches the method of claim 1 as described above. Schultz does not explicitly teach prior to receiving the order, retrieving health care claims data from an external data database and determining a combination of CPT codes for the health care service bundle; assembling the combination of CPT codes into the health care service bundle; and generating the standardized health care service bundle identifier for the health care service bundle. Beck further teaches retrieving health care claims data from an external data database and determining a combination of CPT codes for the health care service bundle; assembling the combination of CPT codes into the health care service bundle; and generating the standardized health care service bundle identifier for the health care service bundle (see paragraph 0042; payment management computer connected to databases including a claim processing system; paragraph 0048; CPT codes used to identify health care service bundle). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 1.
As per claim 6, Schultz and Beck teaches the method of claim 1 as described above. Schultz does not explicitly teach transmitting the claim data to the third-party administrator computing device comprises transmitting the claim data to an electronic data interchange (EDI) system of the third-party administrator computing device. Beck further teaches transmitting the claim data to the third-party administrator computing device comprises transmitting the claim data to an electronic data interchange (EDI) system of the third-party administrator computing device (see paragraphs 0012 and 0026; describes claim submission and EDI). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement claim transmitting in the system of Schultz for the reasons given above with respect to claim 1.
As per claim 7, Schultz and Beck teaches the method of claim 1 as described above. Schultz further teaches receiving, from the third-party administrator computing device, eligibility information for the user (see paragraph 0015; patient eligibility list); and calculating an out-of-pocket cost for the user based on the eligibility information prior to receiving the order (see paragraph 0015; patient eligibility list includes coverage information including co-pays).
As per claim 8, Schultz teaches a system for facilitating health care service transactions, comprising: a processor; a data management module comprising: memory storing processor-executable instructions that cause the processor (see paragraph 0024; computer-based processing system) to: receive, from a consumer computing device, an order for a health care service associated with a standardized health care service identifier (see paragraphs 0008 and 0021; patient and services to be provided are entered and received at third party payor system (part of an e-commerce platform). When entered with the patient card, data entry device being considered as a consumer computing device); transmit, to a provider computing device, order information associated with the order identifying the health care service (see paragraph 0021; medical service provider system displays patient eligibility for reimbursement for the health care service); receive, from the provider computing device, a fulfillment notification indicating the health care service has been provided (see paragraph 0022; medical services provided to patient are entered into the medical service provider system); responsive to receiving the fulfillment notification: generate receipt documentation based on the order information; transmit the receipt documentation in a first format to the consumer computing device (see paragraph 0022; a report (having a first format) is transmitted to the above noted consumer computing device); and transmit data to a third-party administrator computing device (see paragraph 0022; data is transmitted to third party payor for adjudication (e.g. determining co-pays or other fees) and can be posted to a patient file for tracking services provided).
Schultz does not explicitly teach a plurality of standardized health care service bundle identifiers, each standardized health care service bundle identifier associated with a defined set of health care services; and an external data database configured to store health care claims data, receiving an ordered bundle associated with a bundle identifier. Schultz also does not explicitly teach transmitting claim data in a second format different from the first format. Beck teaches a plurality of standardized health care service bundle identifiers, each standardized health care service bundle identifier associated with a defined set of health care services, an external data database configured to store health care claims data, receiving an ordered bundle associated with a bundle identifier (see paragraphs 0047 and 0060; provides bundled services associated with an appropriate code); and transmitting claim data in a second format different from the first format (see paragraphs 0026 and 0054; complete claim is transmitted to payer for adjudication, differing in format from EOBs). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to provide the bundled services and claim transmitting of Beck within the medical services processing system of Schultz with the motivation of more accurately managing patient financial responsibilities for multiple medical services (see paragraph 0047 of Beck).
As per claim 9, Schultz and Beck teaches the system of claim 8 as described above. Schultz does not explicitly teach the memory further stores processor-executable instructions that cause the processor to: retrieve health care claims data from the external data database; process the health care claims data to identify combinations of Current Procedural Technology (CPT) codes provided to a plurality of patients; and generate the plurality of standardized health care service bundle identifiers based on the identified combinations of CPT codes. Beck further teaches the memory further stores processor-executable instructions that cause the processor to: retrieve health care claims data from the external data database; process the health care claims data to identify combinations of Current Procedural Technology (CPT) codes provided to a plurality of patients; and generate the plurality of standardized health care service bundle identifiers based on the identified combinations of CPT codes (see paragraph 0042; payment management computer connected to databases including a claim processing system; paragraph 0048; CPT codes used to identify health care service bundle). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 8.
As per claim 10, Schultz and Beck teaches the system of claim 8 as described above. Schultz does not explicitly teach the first format is a user-friendly format including a non-technical description of services, and wherein the second format is a format compliant with official standards and includes a technical description comprising CPT codes. Beck further teaches the first format is a user-friendly format including a non-technical description of services, and wherein the second format is a format compliant with official standards and includes a technical description comprising CPT codes. (see paragraph 0051; the determination is explained to the patient by the EOB; paragraph 0048; bundled services for which claims are submitted, represented by CPT codes). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 8.
As per claim 11, Schultz and Beck teaches the system of claim 8 as described above. Schultz further teaches the order information is in a third format, and wherein the third format of the order information is different from the first format of the receipt documentation and the second format of the claim data (see paragraphs 0008 and 0021; patient and services to be provided are entered through a third format in the form of a card reader and received at third party payor system).
As per claim 12, Schultz and Beck teaches the system of claim 8 as described above. Schultz further teaches the memory further stores processor-executable instructions that cause the processor to: transmit an eligibility inquiry to the third-party administrator computing device (see paragraph 0015; patient eligibility list); receive eligibility information from the third-party administrator computing device (see paragraph 0015; patient eligibility list includes coverage information including co-pays).
As per claim 13, Schultz and Beck teaches the system of claim 8 as described above. Schultz further teaches an inventory management module configured to manage a service catalog, the service catalog based on a fee schedule for a provider (see paragraph 0008; third party payor system includes a negotiated fee schedule for medical services).
As per claim 14, Schultz and Beck teaches the system of claim 8 as described above. Schultz further teaches the memory further stores processor-executable instructions that cause the processor to: calculate an out-of-pocket cost for a user based on health plan information and pricing information associated with the standardized health care service; and display the out-of-pocket cost via the consumer computing device prior to receiving the order (see paragraph 0015; patient eligibility list includes coverage information including co-pays). As noted above, Schultz does not explicitly teach the healthcare service being bundled. Beck teaches bundled healthcare services (see paragraphs 0047 and 0060; provides bundled services associated with an appropriate code). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 8.
As per claim 15, Schultz teaches a non-transitory computer-readable storage medium including an executable program stored thereon, the program configured to cause a computer processor to: receive, from a consumer computing device, an order for a health care service ((see paragraphs 0008 and 0021; patient and services to be provided are entered and received at third party payor system (part of an e-commerce platform). When entered with the patient card, data entry device being considered as a consumer computing device); transmit order information to a provider computing device (see paragraph 0021; medical service provider system displays patient eligibility for reimbursement for the health care service); receive, from the provider computing device, a fulfillment notification comprising a single order data structure indicating the health care service bundle has been provided (see paragraph 0022; medical services provided to patient are entered into the medical service provider system); and responsive to receiving the fulfillment notification, automatically generate receipt documentation in a first format (see paragraphs 0026 and 0054; complete claim is transmitted to payer for adjudication, differing in format from EOBs). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to provide the bundled services and claim transmitting of Beck within the medical services processing system of Schultz with the motivation of more accurately managing patient financial responsibilities for multiple medical services (see paragraph 0047 of Beck).
Schultz does not explicitly teach the health care services service is a bundle associated with a standardized health care service bundle identifier and transmitting the healthcare service bundle. Schultz also does not explicitly teach generate two different data structures based on the single order data structure, the two different data structures including receipt documentation in a first format and claim data in a second format. Beck teaches bundled health care services associated with a standardized health care service bundle identifier and transmitting the healthcare service bundle (see paragraphs 0047 and 0060; provides bundled services associated with an appropriate code); generate two different data structures based on the single order data structure, the two different data structures including receipt documentation in a first format and claim data in a second format (see paragraph 0051; the determination is explained to the patient by the EOB; paragraph 0048; bundled services for which claims are submitted, represented by CPT codes).
As per claim 16, Schultz and Beck teaches the computer medium claim of claim 15 as described above. Schultz does not explicitly teach the program is further configured to cause the computer processor to: retrieve health care claims data from an external data database; identify combinations of Current Procedural Technology (CPT) codes from the health care claims data; and generate a plurality of standardized health care service bundle identifiers based on the identified combinations of CPT codes. Beck further teaches the program is further configured to cause the computer processor to: retrieve health care claims data from an external data database; identify combinations of Current Procedural Technology (CPT) codes from the health care claims data; and generate a plurality of standardized health care service bundle identifiers based on the identified combinations of CPT codes (see paragraph 0042; payment management computer connected to databases including a claim processing system; paragraph 0048; CPT codes used to identify health care service bundle). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 15.
As per claim 17, Schultz and Beck teaches the computer medium claim of claim 15 as described above. Schultz does not explicitly teach the first format includes a non-technical description of services in user-friendly language, and wherein the second format is compliant with official standards and includes technical descriptions comprising CPT codes. Beck further teaches the first format includes a non-technical description of services in user-friendly language, and wherein the second format is compliant with official standards and includes technical descriptions comprising CPT codes (see paragraph 0051; the determination is explained to the patient by the EOB; paragraph 0048; bundled services for which claims are submitted, represented by CPT codes). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 15.
As per claim 18, Schultz and Beck teaches the computer medium claim of claim 15 as described above. Schultz further teaches the program is further configured to cause the computer processor to: receive eligibility information from the third-party administrator computing device; and store the eligibility information for use in calculating out-of-pocket costs (see paragraph 0015; patient eligibility list includes coverage information including co-pays). Schultz does not explicitly teach transmit an eligibility inquiry to a third-party administrator computing device via an electronic data interchange (EDI) system. Beck further teaches transmit an eligibility inquiry to a third-party administrator computing device via an electronic data interchange (EDI) system (see paragraphs 0012 and 0026; describes claim submission and EDI). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement claim transmitting in the system of Schultz for the reasons given above with respect to claim 15.
As per claim 19, Schultz and Beck teaches the computer medium claim of claim 15 as described above. Schultz further teaches the program is further configured to cause the computer processor to: calculate an out-of-pocket cost based on health plan information and pricing information associated with the standardized health care service (see paragraph 0015; patient eligibility list includes coverage information including co-pays). As noted above, Schultz does not explicitly teach the healthcare service being bundled. Beck teaches bundled healthcare services (see paragraphs 0047 and 0060; provides bundled services associated with an appropriate code). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 15.
As per claim 20, Schultz and Beck teaches the computer medium claim of claim 15 as described above. Schultz further teaches the program is further configured to cause the computer processor to verify eligibility of a user for coverage by a health plan for the health care service prior to calculation of an out-of-pocket cost (see paragraph 0015; patient eligibility list). As noted above, Schultz does not explicitly teach the healthcare service being bundled. Beck teaches bundled healthcare services (see paragraphs 0047 and 0060; provides bundled services associated with an appropriate code). It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to implement bundled services in the system of Schultz for the reasons given above with respect to claim 15.
Conclusion
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure:
Cervenka, Canadian Patent Application No. CA 2770106 A1, discloses responding to a request for an identified healthcare service with cost to a patient.
Myers, US Patent Application Publication No. 2003/0083903, discloses physician validation of services being performed.
Liu et al., e-Health AON (Application-Oriented Networks), discloses a platform for exchanging information regarding healthcare transactions.
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C. Luke Gilligan
Primary Examiner
Art Unit 3683
/CHRISTOPHER L GILLIGAN/ Primary Examiner, Art Unit 3683
