Ex Parte Chapman et al

Patent Trial and Appeal BoardJul 27, 2016

11018189 (P.T.A.B. Jul. 27, 2016)

UNITED STA TES p A TENT AND TRADEMARK OFFICE APPLICATION NO. FILING DATE FIRST NAMED INVENTOR 111018,189 12/20/2004 93261 7590 07/29/2016 Bey & Cotropia PLLC (Trizetto Customer Number) ATTN: Dawn-Marie Bey 213 Bayly Court Richmond, VA 23229 Sherwood Chapman 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. TZGOOl 6-DIV 1 1859 EXAMINER LONG,FONYAM ART UNIT PAPER NUMBER 3626 NOTIFICATION DATE DELIVERY MODE 07/29/2016 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 SHERWOOD CHAPMAN and J. MIKEL ECHEVERRIA Appeal2014--006126 Application 11/018, 189 Technology Center 3600 Before ANTON W. PETTING, BIBHU R. MOHANTY, and MICHAEL W. KIM, Administrative Patent Judges. PETTING, Administrative Patent Judge. DECISION ON APPEAL STATEMENT OF THE CASE1 Sherwood Chapman and J. Mikel Echeverria (Appellants) seek review under 35 U.S.C. Â§ 134 of a final rejection of claims 28-34, 37--41, 45, 47, 49, and 52-55, the only claims pending in the application on appeal. We have jurisdiction over the appeal pursuant to 35 U.S.C. Â§ 6(b ). 2 1 Our decision will make reference to the Appellants' Appeal Brief ("App. Br.," filed February 3, 2014) and Reply Brief ("Reply Br.," filed April 28, 2014), and the Examiner's Answer ("Ans.," mailed February 28, 2014). 2 Claim 43 was cancelled in an amendment filed January 30, 2014 and entered by the Examiner. Advisory Action mailed February 6, 2014. Appeal2014-006126 Application 11/018, 189 The Appellants invented a way of adjudicating medical claims (Specification 1:6-7). This is the second time this application has come before us. Although the art remains the same as in the prior appeal, the claims have been substantially amended. An understanding of the invention can be derived from a reading of exemplary claim 28, which is reproduced below [bracketed matter and some paragraphing added]. 28. A method of processing a medical claim in a medical claim transaction initiated by a submission of the medical claim via an electronic medium to a medical plan provider on behalf of a patient making a visit to a medical service provider, the method comprising: prior to a termination of the patient's visit to the medical service provider: performing, by a computer, an analysis routine compnsmg: [1] identifying, by the computer, a most-recently- received medical claim for the patient received from the medical service provider, where the most-recently-received medical claim can be the medical claim or a different medical claim; [2] analyzing, by the computer, the most-recently- received medical claim in order to determine whether the most-recently- received medical claim is in condition for approval; 2 Appeal2014-006126 Application 11/018, 189 [3] determining that the most-recently-received medical claim is not in condition for approval; [4] rejecting, by the computer, the most-recently- received medical claim; [5] identifying, by the computer, at least one reason the most-recently-received medical claim was rejected; and [ 6] transmitting, by the computer, a message containing information regarding the rejection of the most-recently- received medical claim and the at least one reason for rejection to the medical service provider via the electronic medium, wherein the message enables a creation of the different medical claim and the different medical claim represents an alteration of the most-recently-received medical claim; [7] analyzing, by the computer, the different medical claim in order to determine whether the different medical claim is in condition for approval; [8] determining, by the computer, that the different medical claim is in condition for approval; [9] informing, by the computer, the medical senrice provider via the electronic medium that the different medical claim has been approved; and [ 10] terminating, by the computer, the medical claim transaction. The Examiner relies upon the following prior art: Boyer Alcott US 6,208,973 B 1 WO 91/15817 3 Mar. 27, 2001 Oct. 17, 1991 Appeal2014-006126 Application 11/018, 189 Claims 38--41 and 45 stand rejected under 35 U.S.C. Â§ l 12(b) as failing to particularly point out and distinctly claim the invention. Claims 28-34, 37, 47, 49, and 52-55 stand rejected under 35 U.S.C. Â§ 103(a) as unpatentable over Boyer. Claims 38--41 and 45 stand rejected under 35 U.S.C. Â§ 103(a) as unpatentable over Boyer and Alcott. ISSUES The issues of definiteness tum primarily on whether one of ordinary skill would understand the metes and bounds of the claims. The issues of obviousness tum primarily on whether Boyer describes the claimed steps performed when a claim is not in proper condition. FACTS PERTINENT TO THE ISSUES The following enumerated Findings of Fact (FF) are supported by a preponderance of the evidence. Facts Related to the Prior Art Boyer 01. Boyer is directed to providing adjudicated third party payment at the point of service, and determining at the point of service the portion of a service or product which is to be paid by a third party payor, such as a health insurance company, and the portion of the service or product which is to be paid by the 4 Appeal2014-006126 Application 11/018, 189 customer (patient) and for providing payment settlement at the point of service. Boyer 1 :6-13. 02. FIGS. 8A, 8B and 8C illustrate the life cycle of a claim submitted by a healthcare provider for processing using the adjudicated third party payment system. Boyer 15: 19-34. 03. At step 1.5, the Adjudicated Healthcare Settlement Transaction is generated. In this step, the adjudicated claim is identified, and the claim is checked using conventional credit card fraud detection systems to determine if it is fraudulent. If it is determined that the claim is fraudulent, then a Fraud Transaction is generated and the fraud record is posted to a fraud file and a fraud alert is generated at step 1.10 and sent to a fraud unit. Once the Adjudicated Healthcare Settlement Transaction is generated at step 1.5, the step of remitting the healthcare provider is performed at step 1.6. In particular, the settlement transactions for the healthcare provider are selected and the settlement amounts to payable are summarized. The payable is then posted to a ledger, and an EDI record is generated for ACH payment. The EDI record is transmitted to the healthcare provider's bank, and a payment confirmation from the healthcare provider's bank is received. At this time, the payable is closed as well as the settlement transactions. The credit discount record is then posted to the ledger account of the Internet bank. Boyer 16:9-28. 5 Appeal2014-006126 Application 11/018, 189 Alcott 04. Alcott is directed to real time computerized systems for processing insurance claims. Alcott 1 :7-11. 05. Alcott describes a module used by an insurance or medical provider to determine patient plan eligibility. Alcott 15:5-10. ANALYSIS Claims 38--41, and 45 rejected under 35 U.S. C. Â§ l l 2(b) as failing to particularly point out and distinctly claim the invention For the reasons articulated by the Appellants, we are persuaded that these claims do not omit subject matter essential for one of ordinary skill to understand the metes and bounds of the claims. Claims 28-34, 37, 47, 49, and 52-55 rejected under 35 U.S.C. Â§ 103(a) as unpatentable over Boyer We are persuaded by the Appellants' argument that "Boyer does not in any way disclose the resubmission of an altered medical claim in response to rejection of an initial medical claim. The Examiner simply cites to the same language describing the original and singular submission, review and acceptance/rejection process twice." App. Br. 10. The Examiner finds that Boyer 15:20-35 affords patient an opportunity to correct mistakes. Final Rej. 5. While we would generally agree that any clerical operation based on textual input would likely afford opportunity to correct mistakes, we see nothing in this portion of Boyer that speaks to this and so processing as recited when a 6 Appeal2014-006126 Application 11/018, 189 mistake correction occurs. Instead, Boyer describes the healthcare provider editing a claim during processing. More critically, this does not describe transmitting, by the computer, a message containing information regarding the rejection of the most-recently-received medical claim and the at least one reason for rejection to the medical service provider via the electronic medium, wherein the message enables a creation of the different medical claim and the different medical claim represents an alteration of the most- recently-received medical claim Claim 28. Claims 38--41, and 45 rejected under 35 U.S.C. Â§ 103(a) as unpatentable over Boyer and Alcott We are persuaded by the Appellants' argument that the Examiner made no findings as to the final limitation regarding processing when a claim is not in condition for approval. App. Br. 11. Instead the Examiner construed the claim as always being in condition for approval. Final Rej. 10. This is in error. Claim 38 affirmatively tests whether a claim is in condition and then provides a distinct process flow for each test outcome. 7 Appeal2014-006126 Application 11/018, 189 CONCLUSIONS OF LAW The rejection of claims 38--41 and 45 under 35 U.S.C. Â§ 112(b) as failing to particularly point out and distinctly claim the invention is improper. The rejection of claims 28-34, 37, 47, 49, and 52-55 under 35 U.S.C. Â§ 103(a) as unpatentable over Boyer is improper. The rejection of claims 38--41 and 45 under 35 U.S.C. Â§ 103(a) as unpatentable over Boyer and Alcott is improper. DECISION The rejection of claims 28-34, 37--41, 45, 47, 49, and 52-55 is reversed. REVERSED 8