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EXHIBIT 2

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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE
MCKESSON INFORMATION SOLUTIONS, LLC,
Plaintiff,
Civil Action No. 04-125 8 SLR
v.

THE TRIZETTO GROUP, INC.,
Defendant.

THE TRIZETTO GROUP, INC.'S FOURTH SUPPLEMENTAL RESPONSE TO PLAINTIFF'S INTERROGATORY NO. 6 AND FIRST SUPPLEMENTAL RESPONSE TO PLAINTIFF'S INTERROGATORY NO.21
Pursuant to Rule 33 of the Federal Rules of Civil Procedure, defendant The TriZetto Group, Inc. ("TriZetto") hereby provides the following fourth supplemental response and objections to plaintiff McKesson Information Solutions, LLC's ("McKesson") Interrogatory No.

6 ("Interrogatory No. 6") and first supplemental response and objections to McKesson's Interrogatory No. 21 ("Interrogatory No. 21"). Interrogatory No. 6 was propounded in McKesson's First Set of Intenogatories ("First Set") and Interrogatory No. 21 was propounded in
McKesson's Second Set of Interrogatories ("Second Set") (collectively, the "Interrogatories").

GENERAL OBJECTIONS
1.

TriZetto has not concluded its investigation of the facts relating to this case,

formal discovery, or preparation for trial. For that reason, TriZetto's responses to the

Intenogatories may be incomplete. Moreover, there is a possibility that upon further
investigation, certain details set forth in the responses may be altered or amended. These
responses represent TriZetto's reasonable efforts to provide the information requested based upon

documents or information in its possession, custody, or control, and based upon its current

knowledge. TriZetto reserves its right to produce evidence of any subsequently discovered facts

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and documents, and to alter or amend its factual and legal contentions as additional facts are ascertained, analyses are made, and legal research is completed.
2.

TriZetto objects to McKesson's definition of the term "TriZetto" on the grounds

that such definition is overbroad, unduly burdensome, vague, ambiguous, and causes the

Interrogatories to seek information that is not relevant to the claims, defenses or subject matter of this litigation. As such, TriZetto will interpret "TriZetto" to include The TriZetto Group, Inc.
and its present or former officers, directors and employees.
3.

TriZetto further objects to McKesson's "Definitions" to the extent that they

attempt to place burdens upon TriZefto beyond those required by Rule 33 of the Federal Rules of Civil Procedure. TriZetto will not comply with any "Definitions" that attempt to impose
obligations upon TriZetto not required by Rule 33. 4.

TriZetto objects to the Interrogatories to the extent that they request information

protected from disclosure by any privilege, including the attorney-client privilege or the work

product doctrine. TriZetto and its counsel hereby assert such privileges.
5.

TriZetto objects to each Interrogatory to the extent it seeks information not in

TriZetto's possession, custody, or control on the grounds that it is unduly burdensome and oppressive.
6.

To the extent that any Interrogatory calls for information already in the possession

of McKesson or its counsel, TriZetto objects on the grounds that the Interrogatory is

unnecessary, unduly burdensome and oppressive, and constitutes annoyance, harassment, and
oppression of TriZetto.
7.

TriZetto objects to these Interrogatories to the extent that they seek information

concerning any party or third party which is subject to the right of privacy of that party as

guaranteed by the United States Constitution, any applicable state constitution, or any
combination of the foregoing.
8.

TriZetto will make reasonable efforts to respond to each Interrogatory, to the

extent that no objection is made, as TriZetto understands and interprets the Interrogatory. If

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McKesson subsequently asserts an interpretation of any Interrogatory that differs from that of
TriZetto, TriZetto reserves the right to supplement its objections and responses.
9.

Without waiving any of the foregoing general objections, TriZefto responds to the

Interrogatories, subject to the following additional express reservation of rights:
a.

The right to object on any ground whatsoever to the admission into

evidence or other use of any Interrogatory Responses in any subsequent step or proceeding in
this action or any other action; b.

The right to object on any and all grounds, at any time, to any other

discovery requests or other discovery procedures involving or relating to the subject matter of
these Jnterrogatories; and
c.

The right at any time to revise, correct, add to or clarify any of the

responses propounded herein.
The foregoing general objections and qualifications shall be deemed incorporated in full in the Responses to each specific Interrogatory set forth below.

SUPPLEMENTAL RESPONSES

INTERROGATORY NO.6:
State in complete detail each and every basis for your assertion that the claims of the '164 patent are invalid under 35 U.S.C.
102

or 103. Your response should, without limitation:

identify each prior art reference you contend anticipates any claim of the '164 patent under 35

U.S.C. 102 and each prior art reference or combination of references you contend renders any
claim of the '164 patent obvious under 35 U.S.C. 103; state in complete detail, by means of a claim chart, where TriZetto contends each limitation of any allegedly invalid claim of the '164 patent is disclosed by each reference or combination of references; and state in complete detail

the basis for TriZetto's assertion that one of ordinary skill in the art at the time of the '164
patent's invention would have been motivated to combine or modify any prior art reference or combination of references TriZetto contends is invalidating under 35 U.S.C.
103.

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RESPONSE TO INTERROGATORY NO.6: (January 20, 2005)
TriZetto objects to this interrogatory as vague, ambigubus and compound. TriZetto objects to this interrogatory as overbroad, unduly burdensome and not calculated

to lead to the discovery of admissible evidence. The interrogatory purports to require TriZetto to provide a claim construction for every term of every claim in the '164 patent in the context of providing TriZetto's invalidity contentions. To date, McKesson has not identified which claims
of the '164 patent it is asserting, thus requiring TriZetto to state its claim construction and invalidity contentions for every claim of the '164 patent is unreasonable.

TriZetto objects to this interrogatory on the grounds that it calls for the disclosure of
information protected by the attorney client communications privilege andlor the attorney work

product doctrine. To the extent that TriZetto claims privilege for any information responsive to
this interrogatory and withholds on the basis of privilege, TriZetto will prepare and provide a privilege log in accordance with the Federal Rules of Civil Procedure at a future date. TriZetto objects to this interrogatory on the grounds that it contains multiple sub-parts

and purports to require TriZetto to respond to several different interrogatories through the use of
sub-parts.

TriZetto objects on the basis that discovery and investigation are on-going and it

continues to gather evidence which may affect its answer to this interrogatory. Thus, TriZetto
reserves the right to amend, modify or add to its response to this interrogatory during the course of this lawsuit. Subject to these objections, and TriZetto's General Objections, which are incorporated herein, TriZetto will produce copies of all invalidating prior art of which it is currently aware, or

becomes aware, and that it will provide a claim construction chart setting forth its invalidity
contentions at the appropriate time required by the Court's Scheduling Order.

SUPPLEMENTAL RESPONSE TO INTERROGATORY NO.6: (May 5, 2005)
TriZetto reasserts and reincorporates by reference herein its previous response to

Interrogatory No. 6, and the general objections set forth above. Additionally, claim construction

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in this action has not occurred, and discovery has only just begun with no depositions having been conducted to date. The information contained in this response is based on information that is reasonably available to TriZetto at the present time. TriZetto's identification of prior art is as specific as is possible at this time. Accordingly, TriZetto reserves the right to supplement,
amend and augment its response to this interrogatory as new, additional and different information is learned and discovered and when the claims at issue are construed by the Court. Subject to and without waiving those objections, TriZetto supplements its previous response as
follows:

First, the claims of the '164 patent are invalid and unenforceable against TriZetto because at least three references cited by the patent examiner during prosecution of the '164 patent and 23 additional prior art references together completely disclose and describe the apparatus and methods claimed and described by the '164 patent, rendering the patent invalid as either anticipated or obvious under 35 U.S.C.
102 & 103. Set forth below is a chart of the prior art

references that TriZetto presently contends anticipate one or more claims of the patent in suit or

render one or more claims obvious.

1.

System validates medical fee schedules, Best Review: Life/Health, June 1987, 92

Anticipates/Renders Obvious Anticipates/Renders Obvious

2.

Weitzel, J.R., et al., A Company / University Joint Venture to build a knowledge-based system, MIS Quarterly, Vol. 12, No. 1, March 1988, 23-34

3.

Kerschberg, L. "A Proposal for the Development of an Expert System for Medical Claims Processing: MEDCLAIM," Institute of Information Management, Technology and Policy, College of Business Administration, University of South Carolina, Columbia, SC, (July 1985). Weitzel, J.R. and Kerschberg, L. "Developing Knowledge-Based Systems: Reorganizing the System Development Life Cycle," working paper, University of South Carolina, Columbia, SC and George Mason University, Fairfax, VA (December 1986).

Anticipates/Renders Obvious

4.

Renders Obvious

5

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5.

Ronald Hurst, Cost Containment - The Caterpillar Experience, The Psychiatric Hospital, vol. 13, no. 3 (1982).
Egdahl, M.D. and Hertenstein, M.D., An Accessoriented Negotiated Fee Schedule: The Caterpillar Experience, Aim Surg., 206(3), pp. 349-57 (Sept. 1987).

Renders Obvious

6.

Renders Obvious

7.

Bauer JW, Cassidy TG, DeBord JR, Hart RD, Lee RH, Maher JE, Montgomery CE, Neufeld GK, Rivan RJ, Soderstrom CW, et al., Related Articles, An access oriented negotiated fee schedule: the Caterpillar experience, Ann Surg., 208(5), pp. 667-8 (Nov. 1988). Waterman, Donald A. (The Rand Corporation), A Guide to Expert Systems, Addison-Wesley Publishing, Inc. (1985).

Renders Obvious

8.

Renders Obvious

9.

McDermott, John, Artflcial Intelligence Applications for Business: Building Expert Systems, Proceedings of the NYU Symposium (May 1983).

Renders Obvious

10.

Renders Obvious Gerson, Elihu and Star, Susan Leigh, Analyzing Due Process in the Workplace, ACM Transactions on Office Information systems, vol. 4, no. 3 (July 1986).
Hayes-Roth, Frederick, et. al., Building Expert Systems: An Overview of Expert Systems, Addison Wesley Publishing, Inc. (1985).

11.

Renders Obvious

12.

Taylor, Edward, Developing A Knowledge Engineering Renders Obvious Capability in the TRWDefense Systems: Group, The AT Magazine (Summer 1985)

13.

Bobrow, Daniel, et. al., Expert Systems: Perils and Promise, Computing Practices, Communications of the ACM, vol. 29, no. 9 (Sept. 1986)
Genesereth, Michael, Ginsberg, Matthew, Logic Programming, Communications of the ACM, vol. 28, no. 9 (Sept. 1985).

Renders Obvious

14.

Renders Obvious

15.

Yasdi, Ramin, Modeling Database Based Expert Systems at the Conceptual Level, Proceedings of the 1985 ACM Computer Science Conference (March
1985).

Renders Obvious

6

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16.

Colmerauer, Alain, Prolog in 10 Figures, Communications of the ACM, vol. 28, no. 12 (Dec.
1985).

Renders Obvious

17.

Hayes-Roth, Frederick, Rule-Based Systems, Communications of the ACM, vol. 28, no. 9 (Sept.
1985).

Renders Obvious

18.

Weitzel, J.R. and Kerschberg, L. A System Development Methodology for Knowledge-Based Systems, IEEE Transactions on Systems, Man and Cybernetics, vol. 19, no. 3 (May/June 1989).

Renders Obvious

19.

Winston, Patrick H., Prendergast, Karen A., The Al Business: The Commercial Uses of Artficial Intelligence, The MIT Press (1984)

Renders Obvious

20. 21.
22. 23. 24. 25. 26.

Mack, Barbara, A Prescription for Cutting Corporate Health Expenses, Wall Street Journal (Jul. 18, 1983).
U.S. Pat. No. 4,591,983, issued May 27, 1986 (Bennett patent) U.S. Pat. No. 4,667,292, issued May 19, 1987 (Mohlenbrock patent) U.S. Pat. No. 5,018,067, issued May 21, 1991 (Mohlenbrock 2 patent) U.S. Pat. No. 5,070,452, issued Dec. 3, 1991 (Doyle patent) U.S. Pat. No. 4,803,641, issued Feb. 7, 1989 (Hardy patent) Jap. App!. No. 55-107352, entitled " Medical business system," published Feb. 24, 1982 (Yoshikuni App.)

Renders Obvious Anticipates/Renders Obvious Anticipates/Renders Obvious Renders Obvious Renders Obvious Renders Obvious Anticipates/Renders Obvious

In addition, the fol!owing references in combination with those cited and referenced above render one or more claims of the '164 patent obvious.
1.

Marva J. Crouff, Automating Claims Processing, Insurance Software Review, Autumn 1988, pp. 52, 54. Enhancing Accuracy and Timeliness is Integral to the Claims Adjudication Process, Emp!oyee Benefit Plan Review, Anonymous, Dec. 1985, pp. 10-12.

2. 3.

Expert System identfies miscoded health claims, Bests Review: Life/Health, November 1990,60

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4.
5.

Claims editing software runs coding rule checks, Bests Review: Life/Health, November 1990, 62 Woolsey, C., Employer spots inflated medical bills, Business Insurance, June 25,
1990,3

6.

Leary, E., SSA applies expertise to develop expert systems (Spotlight on Al-expert systems, Social Security Administration), Government Computer News, Vol. 6, No. 17, August 28, 1987, 49(3)

7.
8.

Beard, P., Blue Cross develops insurance claim ES, AIWeek, Vol. 6, No. 7, April 1, 1989, 3 Sullivan-Trainor, M., Catching new clients, Computerworid, Vol. 21, No. 50, December 14, 1987, 95, 99

9.
10.

Snyeder, C., From research to reality: the leading edge of expert systems, Insurance Software Review, Vol. 12, No. 3, Autumn 1987, 22-4, 26-7, 30 Christensen, J., Insuring, High Technology Business, Vol. 8, No. 10, October 1988,47-8
·Expert Systems In the Insurance Industiy: 1987 Survey Report Update, Coopers and Lybrand, 1987

11.

12.

Pallatto, J., Expert system cures the blues (Blue Cross develops insurance claims analysis system NERSys), PC Week, Vol. 5, No. 50, December 12, 1988, 35, 44.

13.

Gladwell, Malcolm, Computer Firm Finds the Link for Health Care, Washington Business, December 5, 1988, 5-6 Freudenheim, Milt, Insurers vs. Doctors: A Software Battleground, New York Times (Nov. 15, 1989) Riordan, Teresa, Patents: A software-technology infringement case against Microsoft goes to trial in Federal Court, New York Times (Jan. 24, 1994). U.S. Pat. No. 4,858,121, issued Aug. 15, 1989 (Barber patent)
U.S. Pat. No. 4,658,370, issued Apr. 14, 1987 (Erman patent)

14.

15.

16. 17.

Second, the '164 patent is invalid under 35 U.S.C. 102(b), because the CodeReview product from McKesson's predecessor in interest was in public use andlor on-sale more than one

year prior to the date that the priority application was filed. This is evidenced by at least the
following publicly available references: (1) U.S. Trademark No. 1,624,579, registered November

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27, 1990 (CodeReview Mark); and (2) Bhide, Amar and Mohan, Brian, Marcia Radosevich and
Health Payment Review: 1989(A), Harvard Business School, 9-394-204 (Feb. 1999). Additional documents produced by McKesson reveal that prior to the CodeReview product being finalized, a "prototype" was being sold, offered for sale and/or given away to customers and prospects well before the priority application was filed. Third, the '164 patent is invalid under 35 U.S.C.
102(a) & 102(g), insofar as the

invention disclosed and claimed therein was made by others and in use by others prior to the date of invention for the '164 patent. Specifically, Medical C Schedule and Audit System and

MediStar from Insurance Software Packages, Inc., and Code Advisor and ClaimCheck from
Gabrieli Medical Information Systems, Inc. These systems were used and offered for sale by others before the date of invention of the '164 patent. Fourth, the '164 patent is invalid under 35 U.S.C.
102(f). The invention described,

disclosed and claimed in the '164 patent was not conceived by the inventors listed in the patent. The claims of the '164 patent each describe and claim a "computer system" that depends upon

and interacts with a "predetermined database stored in the associated memory." TriZetto is
informed and believes that the named inventors lacked sufficient knowledge and detail so as to conceive and/or reduce to practice a "predetermined database stored in the associated memory." Others, who were not identified in the patent were the persons who conceived and reduced this

invention to practice.

SECOND SUPPLEMENTAL RESPONSE TO INTERROGATORY NO.6: (June 20, 2005)
TriZeffo reasserts and reincorporates by reference herein its responses to Interrogatory No. 6 from January 20, 2005 and May 5, 2005, except for the lists of prior art references from the May 5, 2005 supplemental response, which are superseded by the list of prior art references in this response. TriZetto also reasserts and reincorporates by reference herein the general objections set forth above. Claim construction in this action has not occurred, and discovery has only just begun with no depositions having been conducted to date. The information contained in this response is

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based on information that is reasonably available to TriZetto at the present time. TriZetto's identification of prior art is as specific as is possible at this time. Accordingly, TriZetto reserves the right to supplement, amend and augment its response to this interrogatory as new, additional and different information is learned and discovered and when the claims at issue are construed by the Court. Subject to and without waiving those objections, TriZetto supplements its previous response as follows: Claims 1, 2, 3, 4, 6, 9, 10, 11, 12, 13 and 14 of the '164 patent, which McKesson accuses TriZetto of infringing, are invalid and unenforceable against TriZetto because at least 15 references cited in the '164 patent and 71 additional prior art references together completely

disclose and describe the apparatus and methods claimed and described in the asserted claims of
the '164 patent, rendering the patent invalid as either anticipated or obvious under 35 U.S.C.
102 & 103. Set forth below is a chart of the prior art references that TriZetto presently contends

anticipate one or more claims of the patent in suit or render one or more claims obvious. This chart supersedes the lists of prior art references provided in TriZetto's May 5, 2005 supplemental

response.

-

1.

Marva J. Crouff, Automating Claims Processing, Insurance Software Review, Autumn 1988, pp. 52,
54.

Renders Obvious

---

2.

Enhancing Accuracy and Timeliness is Integral to the Renders Obvious Claims Adjudication Process, Employee Benefit Plan Review, Anonymous, Dec. 1985, pp. 10-12.
Healthstar, Health Benefits Management System, Product Description, v. 1.024 (Insurance Software Packages, Inc.)
System validates medical fee schedules, Best Review: Life/Health, June 1987, 92 [Insurance Software Packages, Inc. Medical C Schedule and Audit System]

3.

Renders Obvious

4.

Anticipates/Renders Obvious

5.

Expert System identfies miscoded health claims, Bests Review: Life/Health, November 1 990,6&)

Renders Obvious

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6. 7. 8.

-

Claims editing software runs coding rule checks, Bests Review: Life/Health, November 1990, 62 Woolsey, C., Employer spots inflated medical bills, Business Insurance, June 25, 1990, 3 Weitzel, J.R., et al., A Company / University Joint Venture to build a knowledge-based system, MIS Quarterly, Vol. 12, No. 1, March 1988,23-34
Leary, E., SSA applies expertise to develop expert systems (Spotlight on Al-expert systems, Social Security Administration), Government Computer News, Vol. 6, No. 17, August 28, 1987, 49(3)

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Renders Obvious Renders Obvious Anticipates/Renders Obvious

9.

Renders Obvious

10. 11.

Beard, P., Blue Cross develops insurance claim ES, AIWeek, Vol. 6, No. 7, April 1, 1989, 3 Sullivan-Trainor, M., Catching new clients, Computerworid, Vol. 21, No. 50, December 14, 1987, 95, 99

Renders Obvious
Renders Obvious

12.

Snyeder, C., From research to reality: the leading edge of expert systems, Insurance Software Review, Vol. 12, No. 3, Autunm 1987,22-4,26-7,30
Christensen, J., Insuring, High Technology Business, Vol. 8, No. 10, October 1988, 47-8

Renders Obvious

13. 14. 15.

Renders Obvious Renders Obvious

Expert Systems In the Insurance Industry: 1987 Survey Report Update, Coopers and Lybrand, 1987

Pallatto, J., Expert system cures the blues (Blue Cross Renders Obvious develops insurance claims analysis system NERSys), PC Week, Vol. 5, No. 50, December 12, 1988, 35, 44.

16.

Gladwell, Malcolm, Computer Firm Finds the Link for Health Care, Washington Business, December 5, 1988, 5-6 Kerschberg, L., "A Proposal for the Development of an Expert System for Medical Claims Processing: MEDCLAIM," Institute of Infonriation Management, Technology and Policy, College of Business Administration, University of South Carolina, Columbia, SC, (July 1985).

Renders Obvious

17.

Anticipates/Renders Obvious

11

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18.

Weitzel, J.R. and Kerschberg, L., "Developing Knowledge- Based Systems: Reorganizing the System Development Life Cycle," working paper, University of South Carolina, Columbia, SC and George Mason University, Fairfax, VA (December 1986). Final Publication, April 1989 in Communications of the ACM, Vol. 32, No. 4.
Ronald Hurst, Cost Containment - The Caterpillar Experience, The Psychiatric Hospital, vol. 13, no. 3 (1982).
Egdahl, M.D. and Hertenstein, M.D., An Accessoriented Negotiated Fee Schedule: The Caterpillar Experience, Ann Surg., 206(3), pp. 349-57 (Sept. 1987).

Renders Obvious

19.

Renders Obvious

20.

Anticipates/Render Obvious

21.

22.

Bauer JW, Cassidy TG, DeBord JR, Hart RD, Lee RH, Maher JE, Montgomery CE, Neufeld GK, Rivan RJ, Soderstrom CW, et al., Related Articles, An access-oriented negotiated fee schedule: the Caterpillar experience, Ann Surg., 208(5), pp. 667-8 (Nov. 1988). Waterman, Donald A. (The Rand Corporation), A Guide to Expert Systems, Addison-Wesley Publishing, Inc. (1985).

Renders Obvious

Renders Obvious

23.

McDermott, John, Artflcial Intelligence Applications for Business: Building Expert Systems, Proceedings of the NYU Symposium (May 1983).
Gerson, Elihu and Star, Susan Leigh, Analyzing Due Process in the Workplace, ACM Transactions on Office Information systems, vol. 4, no. 3 (July 1986).

Renders Obvious

24.

Renders Obvious

25.

Hayes-Roth, Frederick, et. al., Building Expert Systems: An Overview of Expert Systems, AddisonWesley Publishing, Inc. (1985).
Taylor, Edward, Developing A Knowledge Engineering Capability in the TR WDefense Systems Group, The Al Magazine (Summer 1985)

Renders Obvious

26.

Renders Obvious

27.

Bobrow, Daniel, et. al., Expert Systems. Perils and Promise, Computing Practices, Communications of the ACM, vol. 29, no. 9 (Sept. 1986)

Renders Obvious

12

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28.

Bhide, Amar and Mohan, Brian, Marcia Radosevich and Health Payment Review. 1989(A), Harvard Business School, 9-394-204 (Feb. 1999)

Renders Obvious

29.

Renders Obvious Genesereth, Michael, Ginsberg, Matthew, Logic Programming, Communications of the ACM, vol. 28, no. 9 (Sept. 1985). Yasdi, Ramin, Modeling Database Based Expert Systems at the Conceptual Level, Proceedings of the 1985 ACM Computer Science Conference (March 1985).
Freudenheim, Milt, Insurers vs. Doctors: A Software Battleground, New York Times (Nov. 15, 1989)

30.

Renders Obvious

31.

Renders Obvious Renders Obvious

32.

Riordan, Teresa, Patents: A software-technology infringement case against Microsoft goes to trial in Federal Court, New York Times (Jan. 24, 1994). Colmerauer, Alain, Prolog in 10 Figures, Communications of the ACM, vol. 28, no. 12 (Dec. 1985).
Hayes-Roth, Frederick, Rule-Based Systems, Communications of the ACM, vol. 28, no. 9 (Sept. 1985).
Weitzel, J.R. and Kerschberg, L., A. System Development Methodology for Knowledge-Based Systems, IEEE Transactions on Systems, Man and Cybernetics, vol. 19, no. 3 (May/June 1989).

33.

Renders Obvious

34.

Renders Obvious

35.

Renders Obvious

36.

Winston, Patrick H., Prendergast, Karen A., The Al Business: The Commercial Uses of Artflcial Intelligence, The MIT Press (1984)

Renders Obvious

37. 38. 39.

Mack, Barbara, A Prescription for Cutting Corporate Health Expenses, Wall Street Journal (Jul. 18, 1983).
U.S. Pat. No. 4,591,983 (Bennett patent) U.S. Pat. No. 4,667,292 (Mohlenbrock patent) U.S. Pat. No. 5,018,067 (Mohlenbrock 2 patent)

Renders Obvious
Anticipates/Renders Obvious Anticipates/Renders Obvious Anticipates/Renders Obvious Anticipates/Renders Obvious Renders Obvious Renders Obvious Anticipates/Renders Obvious

40. 41. 42. 43. 44.

U.S. Pat. No. 5,070,452 (Doyle patent)
U.S. Pat. No. 4,858,121 (Barber patent) U.S. Pat. No. 4,658,370 (Erman patent) U.S. Pat. No. 4,803,641 (Hardy patent)

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45. 46. 47. 48. 49.

Jap. Appl. No. 55-107352, entitled "Medical business Anticipates/Renders Obvious system" (Yoshikuni App.) Renders Obvious U.S. Trademark No. 1,583,416 (ClaimCheck Mark) U.S. Trademark No. 1,624,579 (CodeReview Mark)
U.S. Trademark No. 2,165,159 (Code Advisor Mark)

-----

Renders Obvious Renders Obvious

Renders Obvious Stachura CT, Software reference guide: case-mix management, Journal of the American Medical Record Association [J Am Med Rec Assoc] February 1987, Vol. 58 (2), pp. 42-6.
Stachura CT, Software reference guide: DRG assignment, J Am Med Rec Assoc, January 1987, Vol. 58, (1), pp. 33-40

50.

Renders Obvious

51.

Stachura CT, Software reference guide: encoding, J Am Med Rec Assoc, November 1986, Vol. 57 (11), pp. 25-8 Wilkinson R, Does your grouper 'over-maximize' reimbursement?, Hospitals, October 20, 1986, Vol. 60 (20), pp. 88
Huertas-Cortocarrero D, Ruiz PP, Marmol JP, Concurrent clinical review: using microcomputerbased DRG-s oftware, Health Policy 1988, Vol. 9 (2),

Renders Obvious

52.

Renders Obvious

53.

Renders Obvious

pp.211-7
54.

Nathanson M, Medical records. Experts: more research needed to set value of code programs, Modern Healthcare, June 21, 1985, Vol. 15 (13), pp. 98, 102.

Renders Obvious

55.

Caterinicchio RP, Implementing a DRG-driven acuity Renders Obvious system for nurse staffing under prospective hospital payment, Hospital Topics, May-June 1985, Vol. 63 (3), pp. 6-7, 13 Jackson B, Jensen J, Hospitals turn to new software, hardware to cope with DRG , Modern Healthcare, September 1984, Vol. 14 (12), pp. 109-12 Nathanson M, New software helps hospitals watch costs, profit under DRG, Modem Healthcare, September 1984, Vol. 14 (12), pp. 132, 136-8 DRG helper makes it easy for doctors to maximize reimbursement, Hospital Forum, July-August 1984, Vol. 27 (4), pp. 62-3

56.

Renders Obvious

57.

Renders Obvious

58.

Renders Obvious

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59.

Burda D, Health care market experiences grouper software explosion, J Am Med Rec Assoc, May 1984, Vol. 55 (5), pp. 35-7
Health care executive's guidebook to automation in the 1980s: health care information systems and DRG's, Hospital Forum, Jan-Feb 1984, Vol. 27 (1), pp. 23-30 Goimella JS, Hombrook MC, Louis DZ, Staging of disease. A case mix measurement, Journal of the American Medical Association [JAMA], February 3, 1984, Vol. 251 (5), pp. 637-44

Renders Obvious

60.

Renders Obvious

61.

Renders Obvious

62.

Renders Obvious Ray WJ, Johnstone J, Using medical records to ensure fair DRG reimbursement, Computer in Healthcare, December 1983, Vol. 4 (12), pp. 32-6, 40
Heck S, Esmond T, Financial modeling/case-mix analysis, Computers in Healthcare, June 19:x?:, Vol. 4 (6), pp. 50-1, 54 Moliver M, Computers and reimbursement, Contemporary longterm care, April 1986, Vol. 9 (4), pp. 46-7 Turner JM, DRG compliance measurement in the future, Software in Healthcare, August-September 1985, Vol. 3 (4), pp. 48

63.

Renders Obvious

64.

Renders Obvious

65.

Renders Obvious

66.

Mohlenbrock WC, Getting the most out ofDRG's, Group Practice Journal, September-October 1985, Vol. 34 (5), pp. 27-32
Gibbons PS, Pishotta FT, Stepto RC, A system for reporting gynecologic procedures. A linguisticlogical approach, Journal of Reproductive Medicine, March 1983, Vol. 28 (3), pp. 20 1-5 Studney DR, Hakstian AR, Effect of a computerized ambulatory medical record system on the validity of claims data, Medical Care, April 1983, Vol. 21(4), pp. 463-7 Poulson GP, Detailed costing system nets efficiency, savings, Hospitals, October 1, 1984, Vol. 58 (19), pp. 106-8, 111

Renders Obvious

67.

Renders Obvious

68.

Renders Obvious

69.

Renders Obvious

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-70.

Medical coding, Medical Record and Health Care Information Journal, February 1988, Vol. 29 (1), pp. 20-2

Renders Obvious

71.

Johnson KF, Integrated system brings hospital data together, Health Progress, October 1987, Vol. 68 (8), pp. 46-9, 82 Tauber J, Lahav M, Simplfied diagnostic coding sheet for computerized data storage and analysis in ophthalmology, Ophthalmic Surgery, November 1987, Vol. 18 (11), pp. 8469
Miller KM, Wisnicki HJ, Buclunan JP. Paley MJ, Repka MX, Taylor HR, Guyton DL, The Wilmer Information System. A classification and retrieval system for information on diagnosis and therapy in ophthalmology, Ophthalmology, March 1988, Vol. 95 (3), pp. 403-9

Renders Obvious

72.

Renders Obvious

73.

Renders Obvious

74. 75.

Carter K, PCs can tap databanksjor costs, Modern Healthcare, June 20 1986, Vol. 16 (13), pp. 52
Ohnsson J, GMIS (Gabrieli Medication Information Systems) software flags inappropriate billings, medical procedures, Contract Healthcare, May 1988, pp. 28-9

Renders Obvious Renders Obvious

76.

Renders Obvious Cimino JJ, Review paper: coding systems in health care, Methods of Information in Medicine, December 1996, Vol. 35 (4-5), pp. 273-84
Gabrieli ER, Speth DJ, Chsieaghi B, Knowledge bases, Journal of Clinical Computing, 1985, Vol. 13 (5), pp. 150-4

77.

Renders Obvious

78.

Gabrieli ER, Saumby JA, Computer-based coding of medical data, Topics in Health Record Management, March 1982, Vol. 2 (3), pp. 51-9 Ely RM, Savings through claims audits, Topics in Health Care Financing, Summer 1986, Vol. 12 (4), pp. 61-7
U.S. Pat. No. 4,347,568 (Giguere patent) U.S. Pat. No. 4,491,725 (Pritchard patent)

Renders Obvious

79.

Renders Obvious

80. 81. 82. 83.

Renders Obvious Renders Obvious Renders Obvious

U.S. Pat. No. 4,730,259 (Gallant patent)
U.S. Pat. No. 4,839,822 (Dormond patent).

Renders Obvious

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84.
85.

U.S. Pat. No. 4,937,743 (Rassman patent)
U.S. Pat. No. 4,975,840 (De Tore patent) U.S. Pat. No. 4,991,091 (Allen patent)

Renders Obvious Renders Obvious Renders Obvious

86.

Set forth below is an element-by-element chart mapping the prior art references listed above to each element of the asserted claims of the '164 patent.

1. In a computer system having means for operating on a predetermined database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when input with other selected ones of the medical service codes,

2 (pp. 10-12); 3 (jp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 4l(cols. 2-6).

a method for processing input claims containing at least one medical service code, comprising the steps of: receiving at least one claim;

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 9 10); 41 (cols. 2-6). 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 351-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 2024); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

determining whether any medical service code contained in the at least one claim is not present in the predetermined database; and informing a user that a medical service code is not contained in the predetermined database.

2. In a computer system having means for operating on a predetermined database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when input with other selected ones of the medical service codes,

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

a method for processing input claims containing at least one medical service code, comprising the steps of:

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

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receiving at least one claim;

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3.(pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

ascertaining whether the at least one claim contains a plurality of medical service codes; determining whether one of the medical service codes in the at least one claim is mutually exclusive due to non-medical criteria with any other medical service code in the at least one claim: authorizing medical service codes which are not mutually exclusive due to nonmedical criteria with any other medical service cades contained in the at least one claim in response to the determining step; and rejecting medical service codes which are mutually exclusive due to non-medical criteria with any other medical service codes contained in the at least one claim in response to the determining step.

3.

A computer system including a central processing unit and associated memory for processing input claims containing at least one medical service claim, comprising: a predetermined database stored in the associated memory, the database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when received with other selected ones of the medical service codes;
means for receiving at least one claim;

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 351-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8,

means for ascertaining whether the at least one claim contains a plurality of medical service codes; means for determining whether one of the medical service codes in the plurality of

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medical service codes is valid or invalid by interacting with the database and the set of relationships contained in the database:

11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.
2 (pp. 10-12); 3 (J)p. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

means for authorizing medical service codes which are valid in response to the means for determining; and means for rejecting medical service codes which are invalid in response to the means for determining.

4.

The apparatus of claim 3, further comprising means for revising the at least one claim to delete invalid medical service codes.

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

6.

The apparatus of claim 3, wherein the database containing medical service codes includes medical service codes described by CPT codes.

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 4 (cols. 5-6, 90 10); 41 (cols. 2-6).

The apparatus of claim 3, wherein the relationships among the medical service codes include medically determined relationships.
9.

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 0 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 4 (cols. 5-6, 910); 41 (cols. 2-6).

10. A computer system including a central processing unit and associated memory for processing input claims containing at least one medical service claim, comprising:

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

a predetermined database stored in the associated memory, the database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when received with other selected ones of the

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

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medical service codes; means for receiving at least one claim; 2 (pp. 10-12); 3 (pp. 3-4, 8); 4, 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 351-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

means for ascertaining whether the at least one claim contains a plurality of medical service codes; means for determining whether one of the medical service codes in the at least one claim is included in any other medical service code in the at least one claim;
means for authorizing medical service codes which are not contained in any other medical service code; and means for rejecting medical service codes which axe contained in any other medical service code.

11. The apparatus of claim 10, further comprising means for revising the at least one claim to not include a rejected medical service code.

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

12. A computer system including a ceniral processing unit and associated memory for processing input claims containing at least one medical service code, comprising:

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

a predetermined database. stored in the associated memory, the database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when received with other selected ones of the medical service codes; means for receiving at least one claim;

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

2:(pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15;

means for ascertaining whether the at least

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one claim contains a plurality of medical service codes;

18 (pp. 483, 485); 20 (pp. 351-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

means for determining whether one of the 2 (pp. 10-12); 3 (pp, 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; medical service codes in the at least one 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, claim is medically exclusive with any other 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 medical service code in the at least one (cols. 5-6); 44 (col. 10); 85. claim; means for authorizing medical service codes which are not medically exclusive with any other medical service codes contained in the at least one claim in response to the means for determining;
and means for rejecting medical service codes which are medically exclusive with any other medical service codes contained in the at least one claim in response to the determining step. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

13. A computer system including a central processing unit and associated memory for processing input claims containing at least one medical service code, comprising:

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

a predetermined database stored in the associated memory, the database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes axe valid when received with other selected ones of the medical service codes; means for receiving at least one claim;

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 351-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.
.

means for determining whether any medical service code contained in the at least one claim is not present in the predetermined database; and means for informing a user that a medical service code is not contained in the predetermined database.

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14. A computer system including a central processing unit and associated memory for processing input claims containing at least one medical service code, comprising:

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 39 (cols. 9-12); 40 (cols. 5-6,910); 41 (cols. 2-6).

a predetermined database stored in the associated memory, the database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when received with other selected ones of the medical service codes;
means for receiving at least one claim;

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 351-353); 39 (cols. 9-12); 40 (cols. 5-6, 910); 41 (cols. 2-6).

2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp.483,485); 20 (pp. 351-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85. 2 (pp. 10-12); 3 (pp. 3-4, 8); 4; 5; 6; 8 (pp. 28-30); 10; 12 (p. 26); 15; 18 (pp. 483, 485); 20 (pp. 35 1-353); 22; 27 (p. 882); 34; 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 43 (cols. 5-6); 44 (col. 10); 85.

means for ascertaining whether the at least one claim contains a plurality of medical service codes;. means for determining whether one of the medical service codes in the at least one claim is mutually exclusive due to nonmedical criteria with any other medical service code in the at least one claim: means for authorizing medical service codes which are not mutually exclusive due. to non-medical criteria with any other medical service codes contained in the at least one claim in response to the means for determim , and means for rejecting medical service codes which are mutually exclusive due to non-medical criteria with any other medical service codes contained in the at least one claim in response to the means for determining.

THIRD SUPPLEMENTAL RESPONSE TO INTERROGATORY NO.6: (July 27, 2005)
TriZetto reasserts and reincorporates by reference herein its responses to Interrogatory No. 6 from January 20, 2005, May 5, 2005, and June 20, 2005, except for the lists of prior art references from those previous responses, which are superseded by the lists of prior art

references in this response. TriZetto also reasserts and reincorporates by reference herein the general objections set forth above.

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Claim construction in this action has not occurred, and discovery has only just begun. The information contained in this response is based on information that is reasonably available to

TriZetto at the present time. TriZetto's identification of prior art is as specific as possible at this time. Accordingly, TriZetto reserves the right to supplement, amend and augment its response to
this interrogatory as new, additional and different information is learned and discovered and

when the claims at issue are construed by the Court. Subject to and without waiving those
objections, TriZetto supplements its previous response as follows: Claims 1, 2, 3, 4, 6, 9, 10, 11, 12, 13 and 14 of the '164 patent, which McKesson accuses TriZetto of infringing, are invalid and unenforceable against TriZetto because at least 19 prior art references together completely disclose and describe the apparatus and methods claimed in the asserted claims of the '164 patent, rendering the patent invalid as either anticipated or obvious

under 35 U.S.C.

102 & 103. Set forth below is a chart of the prior art references that TriZetto

presently contends anticipate one or more claims of the patent in suit or render one or more

claims obvious. This chart supersedes the lists of prior art references provided in TriZetto's previous supplemental responses.

2.

Enhancing Accuracy and Timeliness is Integral to the Renders Obvious Claims Adjudication Process, Employee. Benefit Plan Review, Anonymous, Dec. 1985, pp. 10-12.
Weitzel, J.R., et al., A Company / University Joint Venture to build a knowledge-based system, MIS Quarterly, Vol. 12, No. 1, March 1988, 23-34

8.

Anticipates/Renders Obvious

12.

Snyeder, C., From research to reality: the leading edge of expert systems, Insurance Software Review, Vol. 12, No. 3, Autumn 1987, 22-4, 26-7, 30
Weitzel, J.R. and Kerschberg, L., "Developing Knowledge- Based Systems: Reorganizing the System Development Life Cycle," working paper, University of South Carolina, Columbia, SC and George Mason University, Fairfax, VA (December 1986). Final Publication, April 1989 in Communications of the ACM, Vol. 32, No. 4.

Renders Obvious

18.

Renders Obvious

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20.

Bgdahl, M.D. and Hertenstein, M.D., An Accessoriented Negotiated Fee Schedule: The Caterpillar Experience, Aim Surg., 206(3), pp. 349-57 (Sept. 1987).

Anticipates/Renders Obvious

38. 39.

U.S. Pat. No. 4,591,983 (Bennett patent)
U.S. Pat. No. 4,667,292 (Mohlenbrock patent) U.S. Pat. No. 5,018,067 (Mohlenbrock 2 patent)

Anticipates/Renders Obvious Anticipates/Renders Obvious Anticipates/Renders Obvious Anticipates/Renders Obvious Anticipates/Renders Obvious Renders Obvious

40. 41. 44.
50.

U.S. Pat. No. 5,070,452 (Doyle patent)
U.S. Pat, No. 4,803,641 (Hardy patent)

Stachura CT, Software reference guide: DRG assignment, J Am Med Rec Assoc, January 1987, Vol. 58, (l),-pp. 33-40
Huertas-Cortocarrero D, Ruiz PP, Marniol JP, Concurrent clinical review: using microcomputerbased DRG-software, Health Policy 1988, Vol. 9 (2),

53.

Renders Obvious

pp,2ll-7
54.

Nathanson M, Medical records. Experts: more research needed to set value of code programs, Modem Healthcare, June 21, 1985, Vol. 15 (13), pp. 98, 102. Gonnella JS, Hombrook MC, Louis DZ, Staging of disease. A case mix measurement, Journal of the American Medical Association [JAMA], February 3, 1984, Vol. 251 (5), pp. 637-44
Gibbons PS, Pishotta FT, Stepto RC, A system for reporting gynecologic procedures. A linguisticlogical approach, Journal of Reproductive Medicine, March 1983, Vol. 28 (3), pp. 20 1-5

Renders Obvious

61.

Renders Obvious

67.

Renders Obvious

73.

Miller KM, Wisnicki HJ, Buchman IP. Riley MJ, Repka MX, Taylor HR, Guyton DL, The Wilmer Information System. A classification and retrieval system for information on diagnosis and therapy in ophthalmology, Ophthalmology, March 1988, Vol. 95 (3), pp. 403-9

Renders Obvious

82. 83.

U.S. Pat. No. 4,730,259 (Gallant patent)
U.S. Pat. No. 4,839,822 (Dormond patent)

Renders Obvious Renders Obvious

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88.

Hao Kuo, MEDCLAIM: An Expert Support System for Medical Claims Review, Thesis Submitted in Department of Computer Science, University of South Carolina (1986).

Anticipates/Renders Obvious

Set forth below is an element-by-element chart mapping the prior art references listed above to each element of the asserted claims of the '164 patent.

1. In a computer system having means for operating on a predetermined database containing medical service codes and a set of relationships among the medical service codes defming whether selected ones of the medical service codes are valid when input with other selected ones of the medical service codes,

8 (pp. 28-30); 18 (pp. 483, 485); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 61 (pp. 639640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

a method for processing input claims containing at least one medical service code, comprising the steps of:

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).
2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52). 2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

receiving at least one claim;

determining whether any medical service code contained in the at least one claim is not present in the predetermined database; and informing a user that a medical service code is not contained in the predetermined database.

2.

In a computer system having means for operating on a predetermined database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when input with other selected ones of the medical service codes, a method for processing input claims

8 (pp. 28-30); 18 (pp. 483, 485); 38 (cols. 3-8, 1-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 61 (pp. 639640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351-

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containing at least one medical service code, comprising the steps of:

353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98) 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52). 2 (pp. 10-12); 8 (pp: 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 1-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 20 1-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44-52). 2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 20 1-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52). 2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52). 2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

receiving at least one claim;

ascertaining whether the at least one claim contains a plurality of medical service codes;

determining whether one of the medical service codes in the at least one claim is mutually exclusive due to non-medical criteria with any other medical service code in the at least one claim; authorizing medical service codes which are not mutually exclusive due to nonmedical criteria with any other medical service cades contained in the at least one claim in response to the determining step; and rejecting medical service codes which are mutually exclusive due to non-medical criteria with any other medical service codes contained in the at least one claim in response to the determining step.

A computer system including a central processing unit and associated memory for processing input claims containing at least one medical service claim, comprising:
a predetermined database stored in the associated memory, the database containing medical service codes and a set of relationships among the medical service codes defining whether selected ones of the medical service codes are valid when received with other selected ones of the medical service codes; means for receiving at least one claim;

3.

8 (pp. 28-30); 18 (pp. 483, 485); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 61 (pp. 639640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 61 (pp. 639-640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

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means for ascertaining whether the at. least one claim contains a plurality of medical service codes;

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353), 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52). 2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).
2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485), 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

means for determining whether one of the medical service codes in the plurality of medical service codes is valid or invalid by interacting with the database and the set of relationships contained in the database; means for authorizing medical service codes which are valid in response to the means for determining; and means for rejecting medical service codes which are invalid in response to the means for determining.

4.

The apparatus of claim 3, further comprising means for revising the at least one claim to delete invalid medical service codes.

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

6. The apparatus of claim 3, wherein the database containing medical service codes includes medical service codes described by CPT codes.

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 1-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

The apparatus of claim 3, wherein the relationships among the medical service codes include medically determined relationships.
9.

2 (pp. 10-12); 8 (pp. 28-30); 12 (p. 26); 18 (pp. 483, 485); 20 (pp. 351353); 38 (cols. 3-8, 11-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 50 (pp. 34, 37, 39-40); 53 (p. 216); 54 (p. 98); 61 (pp. 639-640); 67 (pp. 201-202); 73 (pp. 403-405, 408); 82 (cols. 1-4); 83 (cols. 2-3, 7-8); 88 (pp. 2-3, 26, 30-40, 44, 52).

ri

A computer system including a centra1 processing unit and associated

8 (pp. 28-30); 18 (pp. 483, 485); 38 (cols. 3-8, 1 1-16, 20-24); 39 (cols. 9-12); 40 (cols. 5-6, 9-10); 41 (cols. 2-6); 44 (col. 10); 61 (pp. 639-

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memory for processing input claims containing at least one medical service claim, comprising:
a predetermined database stored in the associated memory, the database containin