Ex Parte Burriss et alDownload PDFPatent Trial and Appeal BoardAug 19, 201611757154 (P.T.A.B. Aug. 19, 2016) Copy Citation UNITED STA TES p A TENT AND TRADEMARK OFFICE APPLICATION NO. FILING DATE FIRST NAMED INVENTOR 111757, 154 06/01/2007 93261 7590 08/23/2016 Bey & Cotropia PLLC (Trizetto Customer Number) ATTN: Dawn-Marie Bey 213 Bayly Court Richmond, VA 23229 Melony D. Burriss UNITED STATES DEPARTMENT OF COMMERCE United States Patent and Trademark Office Address: COMMISSIONER FOR PATENTS P.O. Box 1450 Alexandria, Virginia 22313-1450 www .uspto.gov ATTORNEY DOCKET NO. CONFIRMATION NO. TZG0022 2160 EXAMINER NGUYEN, TRAN N ART UNIT PAPER NUMBER 3686 NOTIFICATION DATE DELIVERY MODE 08/23/2016 ELECTRONIC Please find below and/or attached an Office communication concerning this application or proceeding. The time period for reply, if any, is set in the attached communication. Notice of the Office communication was sent electronically on above-indicated "Notification Date" to the following e-mail address( es): dawnmarie@beycotropia.com bey _cotropia_docketing@cardinal-ip.com PTOL-90A (Rev. 04/07) UNITED STATES PATENT AND TRADEMARK OFFICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Ex parte MELONY D. BURRISS, DALEE. HOERLE, and DAN SPIREK Appeal2014--001828 Application 11/757,154 Technology Center 3600 Before HUBERT C. LORIN, ANTON W. PETTING, and JOSEPH A. FISCHETTI, Administrative Patent Judges. PETTING, Administrative Patent Judge. DECISION ON APPEAL STATEMENT OF THE CASE1 Melony D. Burriss, Dale E. Hoerle, and Dan Spirek (Appellants) seek review under 35 U.S.C. § 134 of a final rejection of claims 1-7, 9-20, 22- 32, 34--37, 45, and 50-52, the only claims pending in the application on appeal. We have jurisdiction over the appeal pursuant to 35 U.S.C. § 6(b). The Appellants invented a way of processing of health care information. Specification para. 4. 1 Our decision will make reference to the Appellants' Appeal Brief ("App. Br.," filed July 8, 2013) and Reply Brief ("Reply Br.," filed November 25, Appeal2014-001828 Application 11/757,154 An understanding of the invention can be derived from a reading of exemplary claim 1, which is reproduced below (bracketed matter and some paragraphing added). 1. A method comprising: [ 1 ] receiving, at a claim processing computer system that is operable to adjudicate an actual claim for payment from an insurer for services rendered to a healthcare consumer, a request for estimated healthcare payment information for a service upon the healthcare consumer scheduling an appointment regarding the service with a service provider, wherein said receiving a request comprises receiving a mock claim for the service, and wherein the mock claim is in a common format as the actual claim for a service that has been rendered to the healthcare consumer with an indicator that indicates the mock claim is not to be presently committed for payment by the msurer; 2013), and the Examiner's Answer ("Ans.," mailed September 27, 2013), and Final Action ("Final Act.," mailed February 15, 2013). 2 Appeal2014-001828 Application 11/757,154 [2] processing said request by said claim processing computer system for determining the requested estimated healthcare payment information, and wherein the claim is not committed for payment by said msurer, but would have been adjudicated for payment by the claim processing computer system but for the existence of the indicator; [3] communicating, from the claim processing computer system, a response to the request that includes the estimated healthcare payment information The Examiner relies upon the following prior art: Pritchard US 4,491,725 Jan. 1, 1985 Goguen US 2004/0064386 Al Apr. 1, 2004 Claims 1-7, 9-20, 22-32, 34--37, 45, and 48-52 stand rejected under 35 U.S.C. § 103(a) as unpatentable over Pritchard and Goguen. ISSUES The issues of obviousness tum primarily on whether Pritchard describes a field that can flag a transactional form as being a request for information only. 3 Appeal2014-001828 Application 11/757,154 FACTS PERTINENT TO THE ISSUES The following enumerated Findings of Fact (FF) are believed to be supported by a preponderance of the evidence. Facts Related to Claim Construction 01. The disclosure contains no lexicographic definition of "mock claim." Facts Related to Appellants' Disclosure 02. In certain embodiments, the request for estimated healthcare information comprises a "mock" claim for the service that has not been rendered to the healthcare consumer. According to certain embodiments, the "mock" claim is substantially the same as an actual claim that is received by the claim adjudication system, but the "mock" claim is not committed/posted by the claim adjudication system. Thus, the claim adjudication system can process the mock claim just as an actual claim in order to obtain healthcare information pertaining to such mock claim (e.g., the consumer's liability for the services identified in the mock claim, etc.), but the claim adjudication system does not actually commit the claim for payment by an insurer. According to certain embodiments, the mock claim contains an indicator that indicates to the claim processing system that the adjudicated claim should not presently be committed/posted, as would an actual claim for a service that has been rendered to the consumer. The mock claim may be in a common format as an actual claim for a service that has been rendered to the healthcare consumer, and is adjudicated 4 Appeal2014-001828 Application 11/757,154 by the claim processing system substantially as would an actual claim, except for being committed/posted. For example, according to certain embodiments of the present invention, a common user interface may be used for inputting information for either a "mock" claim or an actual claim. Once the information is input, the user can either submit the information as an actual claim (e.g., using a "submit claim" button on the user interface) or can submit the information as a mock claim (e.g., using a "request estimate" button on the user interface) to obtain an estimate of the healthcare information pertaining to the claim. Spec. para. 35. Facts Related to the Prior Art Pritchard 03. Pritchard is directed to the evaluation of medical insurance coverage, the determination of claim payment schedules, and the processing of insurance claim payments. Pritchard 1:6-10. 04. Pritchard describes a service provider entering health service data into a standardized form. The standardized claim form is completed in all respects except for the entry of a yes/no regarding the assignment provision of the insurance payment to the service provider or to the patient. The form is then transmitted electronically and is examined to determine if it has been correctly prepared to meet the requirements of the patient's insurance carrier. Pritchard 7:37-8:8. 05. Pritchard describes converting a correctly prepared claim form during which the CPT-IV code, which was entered by the service 5 Appeal2014-001828 Application 11/757,154 provider into the standard form, is converted for the appropriate insurance carrier. Next, the file for that particular carrier is referenced with the selected service code. This service code is then used to read the claim payment for that particular service code. This claim payment amount is then transmitted, together with a control number for the particular claim. Pritchard 8:9-23. 06. Pritchard describes how, with this information displayed, the patient and service provider can read the claim payment amount that the patient's insurance carrier will pay for a particular service or collection of services. Both parties are much more informed as to the economic considerations of the service or treatment transaction of the insurance claim payment which may be submitted to the patient's insurance carrier. Pritchard 8:57---63. 07. Pritchard describes the service provider being able to render an immediate bill to the patient, if a service has been provided, for the differential between his charged fee and the reimbursement that he will receive from the insurance carrier if the displayed insurance payment does not satisfy the service provider's fee. Pritchard 8:57---63. Goguen 08. Goguen is directed to electronic bill submission and processing, and in particular to insurance claims corresponding to providers of insurance services. Goguen para. 2. 09. Goguen describes the use of a VOID transaction indicator or flag. Goguen para. 52. 6 Appeal2014-001828 Application 11/757,154 ANALYSIS We adopt the Examiner's findings and analysis from Final Action 2-9 and Answer 2-9 and reach similar legal conclusions. We now tum to the Reply Brief. We are not persuaded by Appellants' argument that neither Pritchard nor Goguen teach or suggest a "mock claim." Reply Br. 2--4. Contrary to Appellants' contention, the term "mock claim" is not lexicographically defined. Reply Br. 3. Appellants cite Specification paragraph 35, which only describes suggested embodiments. FF 01---02. Further even that paragraph describes a mock claim as "substantially the same as an actual claim that is received by the claim adjudication system, but the 'mock' claim is not committed/posted by the claim adjudication system." Id. at FF 02. Pritchard describes this almost exactly. FF 04---07. Pritchard uses an assignment provision field to flag its equivalent of a mock claim. A space character entered in that field flags the record as a mock record. As the embodiment described in the Specification does, Pritchard then uses the mock record to look up and return a cost estimate. We are not persuaded by Appellants' argument that Pritchard is not cited for teaching the claimed "mock claim." Reply Br. 4--6. Appellants contend that the use of a space character in Pritchard negates the form's characterization as a mock claim. Id. The problem for the Appellants is that such an argument makes any form of mock claim literally impossible where a mock claim differs in some respect to indicate its mock nature. The claims are not that contrarian. Instead, the claims only require a common format, which Pritchard describes. 7 Appeal2014-001828 Application 11/757,154 We find that Appellants' argument further relies on an embodiment that is mutually exclusive with the recited claim limitations. Appellants argue an alternative embodiment that relies on user selection of one of two navigational buttons to indicate whether a transaction is real or mock. The claim as recited instead relies on an indicator that indicates the mock claim is not to be presently committed. We are not persuaded by Appellants' argument that Goguen fails to rectify the deficiencies of Pritchard and further fails to teach or suggest "an indicator that indicates the mock claim is not to be presently committed for payment by the insurer." Reply Br. 6-9. The Examiner cited Goguen only for a more explicit example of a field designed to negate a transaction effect. CONCLUSIONS OF LAW The rejection of claims 1-7, 9-20, 22-32, 34--37, 45, and 48-52 under 35 U.S.C. § 103(a) as unpatentable over Pritchard and Goguen is proper. DECISION The rejection of claims 1-7, 9-20, 22-32, 34--37, 45, and 50-52 is affirmed. No time period for taking any subsequent action in connection with this appeal may be extended under 37 C.F.R. § 1.136(a). See 37 C.F.R. § 1.136(a)(l)(iv) (2011). AFFIRMED 8 Copy with citationCopy as parenthetical citation