Ex Parte Chapman et al

Patent Trial and Appeal Board

Jan 15, 2013

11018189 (P.T.A.B. Jan. 15, 2013)

UNITED STATES PATENT AND TRADEMARK OFFICE 1
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BEFORE THE BOARD OF PATENT APPEALS 4
AND INTERFERENCES 5
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Ex parte SHERWOOD CHAPMAN 8
and J. MIKEL ECHEVERRIA 9
___________ 10
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Appeal 2011-003357 12
Application 11/018,189 13
Technology Center 3600 14
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Before ANTON W. FETTING, BIBHU R. MOHANTY, and 18
MICHAEL W. KIM, Administrative Patent Judges. 19
FETTING, Administrative Patent Judge. 20
DECISION ON APPEAL 21
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STATEMENT OF THE CASE1 1

1 Our decision will make reference to the Appellants’ Appeal Brief (“App.
Br.,” filed September 29, 2010) and Reply Brief (“Reply Br.,” filed
December 14, 2010), and the Examiner’s Answer (“Ans.,” mailed October
14, 2010).
Sherwood Chapman and J. Mikel Echeverria (Appellants) seek review 2
under 35 U.S.C. § 134 of a final rejection of claims 28-34, 36-43, and 45-58, 3
the only claims pending in the application on appeal. We have jurisdiction 4
over the appeal pursuant to 35 U.S.C. § 6(b). 5
The Appellants invented a way of adjudicating medical claims 6
(Specification 1:6-7). 7
An understanding of the invention can be derived from a reading of 8
exemplary claim 38, which is reproduced below [bracketed matter and some 9
paragraphing added]. 10
38. An interactive claims processing method comprising: 11
[1] receiving a medical claim 12
via an electronic medium 13
on behalf of a patient of a medical service provider 14
while the patient is in an office of the medical service 15
provider, 16
thereby initiating a medical claim transaction; 17
and 18
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[2] while the patient remains in the office of the medical service 1
provider: 2
[3] analyzing, 3
by a computer, 4
the medical claim 5
in order to determine 6
whether the medical claim is in 7
condition for approval; 8
[4] if the medical claim is in condition for approval: 9
[4a] approving, by the computer, the medical claim 10
so the medical service provider can accept 11
payment for the medical claim; 12
and 13
[4b] informing, by the computer, the medical 14
service provider via the electronic medium that the 15
medical claim has been approved; 16
[5] if the medical claim is not in condition for approval: 17
[5a] identifying, by the computer, an alteration that 18
would place the medical claim in condition for 19
approval; 20
and 21
[5b] transmitting, by the computer, a message 22
containing information regarding a rejection of the 23
medical claim and the alteration to the medical 24
service provider via the electronic medium. 25
26
The Examiner relies upon the following prior art: 27
Boyer US 6,208,973 B1 Mar. 27, 2001
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Claims 28-34, 36-43, 45-55, 57, and 58 stand rejected under 35 U.S.C. § 1
102(b) as anticipated by Boyer. 2
Claims 56 and 58 stand rejected under 35 U.S.C. § 103(a) as 3
unpatentable over Boyer. 4
ISSUES 5
The issues of anticipation and obviousness turn primarily on the steps 6
recited for the condition for approval branch. 7
FACTS PERTINENT TO THE ISSUES 8
The following enumerated Findings of Fact (FF) are believed to be 9
supported by a preponderance of the evidence. 10
Facts Related to the Prior Art - Boyer 11
01. Boyer is directed to providing adjudicated third party payment 12
at the point of service, and determining at the point of service the 13
portion of a service or product which is to be paid by a third party 14
payor, such as a health insurance company, and the portion of the 15
service or product which is to be paid by the customer (patient) 16
and for providing payment settlement at the point of service. 17
Boyer 1:6-13. 18
02. FIGS. 8A, 8B and 8C illustrate the life cycle of a claim 19
submitted by a healthcare provider for processing using the 20
adjudicated third party payment system. Boyer 15:19-34. 21
03. At step 1.5, the Adjudicated Healthcare Settlement Transaction 22
is generated. In this step, the adjudicated claim is identified, and 23
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the claim is checked using conventional credit card fraud detection 1
systems to determine if it is fraudulent. If it is determined that the 2
claim is fraudulent, then a Fraud Transaction is generated and the 3
fraud record is posted to a fraud file and a fraud alert is generated 4
at step 1.10 and sent to a fraud unit. Once the Adjudicated 5
Healthcare Settlement Transaction is generated at step 1.5, the 6
step of remitting the healthcare provider is performed at step 1.6. 7
In particular, the settlement transactions for the healthcare 8
provider are selected and the settlement amounts to payable are 9
summarized. The payable is then posted to a ledger, and an EDI 10
record is generated for ACH payment. The EDI record is 11
transmitted to the healthcare provider's bank, and a payment 12
confirmation from the healthcare provider's bank is received. At 13
this time, the payable is closed as well as the settlement 14
transactions. The credit discount record is then posted to the 15
ledger account of the Internet bank. Boyer 16:9-28. 16
ANALYSIS 17
All claims are method claims. All independent claims contain two 18
mutually exclusive method branches. Which branch is executed depends on 19
whether a medical claim is in condition for approval. Both Examiner and 20
Appellants agree that the claims are anticipated if all of the steps in either of 21
the branches are anticipated, as only one branch can be executed by virtue of 22
their mutual exclusion. The branch for the medical claim not being in 23
condition for approval is not at issue, as the Examiner made findings for the 24
branch where the claim is in condition for approval alone. 25
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The steps recited for the condition for approval branch are approving, by 1
the computer, the medical claim so the medical service provider can accept 2
payment for the medical claim; and informing, by the computer, the medical 3
service provider via the electronic medium that the medical claim has been 4
approved. 5
We are not persuaded by the Appellants’ argument that 6
once Boyer adjudicates the claim, the payment for the claim is 7
automatically processed. Although the patient must eventually 8
sign the transaction receipt, the settlement process is initiated 9
immediately upon the adjudication of the claim. In contrast, 10
claim 28 recites how the medical service provider is informed 11
of the approval so that the medical service provider can accept 12
payment. As a result, a patient can choose a form of payment 13
once the claim is approved. 14
App. Br. 9. The approval step is admitted, as it is evident by the very 15
condition of being in condition for approval. The informing step is 16
contested. The claim does not narrow the manner of informing. Appellants 17
argue that bifurcating informing from payment processing provides an 18
advantage, but the claim does not recite such bifurcation. Clearly processing 19
the claim and transmitting the processed claim to a party informs that party 20
of the processing. As Boyer creates an EDI transaction, this is an 21
informational transaction that informs the recipient of the transaction so as to 22
accept the ACH payment, albeit automatically. 23
As to the rejection of claims 56 and 58 under obviousness, we agree with 24
the Examiner that no official notice was implied or otherwise taken, but that 25
interjecting a manual check in an otherwise automated process and timing 26
payment either before or after service are well known and predictable 27
variants of transactions in all venues including medical transactions. 28
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CONCLUSIONS OF LAW 1
The rejection of claims 28-34, 36-43, 45-55, 57, and 58 under 35 U.S.C. 2
§ 102(b) as anticipated by Boyer is proper. 3
The rejection of claims 56 and 58 under 35 U.S.C. § 103(a) as 4
unpatentable over Boyer is proper. 5
DECISION 6
The rejection of claims 28-34, 36-43, and 45-58 is affirmed. 7
No time period for taking any subsequent action in connection with this 8
appeal may be extended under 37 C.F.R. § 1.136(a). See 37 C.F.R. 9
§ 1.136(a)(1)(iv) (2011). 10
AFFIRMED 11
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ewh 18