Free Opening Brief in Support - District Court of Delaware - Delaware

Case 1:04-cv—01258-SLR Document 170-2 Filed 12/16/2005 Page 1 of 4
Appendix A: Table Summarizing Disputed Means-Plus-Function Elements
(Elements that the parties agree are subject to construction under section ll2(6) are indicated by
italicizing the "meansf0r" language.)
1tir/ gtgdc /i itebrie if /ttgg/gct cttt ttu , u c 1 1iit/ 1 eeee t eectc r /u////e A tttti te/t
zét- a 0* ‘=1=; ; - :t;.;-== . `‘i` C*iléli*·¤ -;;u:=t= tlll lll=Eu.E... a
. A _it-is’M‘i‘?"S*iii”S“liV””ll!ll’i" tréamatsvf arf?. ] d`1id itd
"merms for operating on a Appears verbatim in preamble of independent claims 1,
predetermined database" 2 and 16.
·iiMeahs-Plds$`Fdnetivriii _
"A computer system including a Appears verbatim in independent claims 3, 10, 12, 13,
central processing unit and 14 and 15. (Although not containing any means—plus-
[ associated memory for processing function limitations, this element is included for
input claims containing at least one context.)
medical service code, comprising:"
[a] "a predetermined database Appears verbatim in independent claims 3, 10, 12, 13,
stored in the associated memory, 14 and 15. (Although not containing any means-plus-
the database containing medical function limitations, this element is included for
service codes and a set of context.)
relationships among the medical
service codes defining whether
selected ones ofthe medical service
codes are valid when received with
other selected ones of the medical
service codes";
[b] "means for receiving at least Appears verbatim in independent claims 3, 10, 12, 13,
one claim"; 14 and 15.
[c] "meansf0r ascertaining whether Appears verbatim in independent claims 3, 10, 12, 14
the at least one claim contains a and 15, but does not appear in claim 13.
plurality of medical service codes";
[d] "meaas_fbr determining whether ln claims 3 and 15, the [criterion] is "valid or invalid by
one of the medical service codes in interacting with the database andthe set of relationships
the at least one claim is [criterion]"; contained in the database." (Also, the claim language
"in the at least one claim" is replaced by "in the
plurality of medical service codes.")
ln claim 10, the [criterion] is "included in any other
medical service code in the at least one claim";
In claim 12, the [criterion] is "medically exclusive with
any other medical service code in the at least one
claim";
In claim 13, the [criterion] is "not present in the
predetermined database" (Also, the claim language
[ "one of the medical service codes in the at least one
claim" is replaced by "any medical service code
contained in the at least one claim.")
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Case 1:04-cv—01258-SLR Document 170-2 Filed 12/16/2005 Page 2 of 4
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Eeg ie v I
In claim 14, the [criterion] is "mutually exclusive due to
non—medica1 criteria with any other medical service
code in the at least one claim."
[e] "metms for authorizing medical In claim 3, codes [meet criterion] if they "are valid."
Servrgs eeden Wnlen [meet In claim 10, codes [meet criterion] if they "are not
enlenenl {nfeeljnnne te tne Inenne contained in any other medical service code." (Also,
fm d¤t¤rm¤¤¤¤a 3 and this element of claim 10 does not include the language,
"in response to the means for determining.")
In claim 12, codes [meet criterion] if they "are not
medically exclusive with any other medical service
codes contained in the at least one claim."
(This element is not present in claim 13.)
In claim 14, codes [meet criterion] if they "are not
mutually exclusive due to non-medical criteria with any
other medical service codes contained in the at least one
claim."
In claim 15, this element reads: "means for authorizing
the at least one claim in response to the means for
determining?
[t] "means for rejecting medical In claim 3, codes [fail criterion] if they "are invalid."
eewiee eenee which [fen entenenl ln claim 10, codes [fail criterion] if they "are contained
In Yeeljeneel tn the means fm in any other medical service code. (Also, this element
determining- of claim 10 does not include the language, "in response
to the means for determining.")
In claim 12, codes [fail criterion] if they "are medically
exclusive with any other medical service codes
contained in the at least one c1aim." (Claim 12 replaces
the language, "means for determining" with
"determining step.")
(This element is not present in claim 13.)
In claim 14, codes [fail criterion] if they "are mutually
exclusive due to non-medical criteria with any other
medical service codes contained in the at least one
c1aim."
In claim 15, this element reads: "means for rejecting the
at least one claim in response to the means for
determining."
(g) "merrnsfir informing a user that This element appears in claim 13; it does not appear in
a medical service code is not claims 3, 10, 12, 14, 15
contained in the predetermined
database."
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Case 1:04-cv—01258-SLR Document 170-2 Filed 12/16/2005 Page 3 of 4
Appendix B: Table Summarizing TriZett0's Constructions
for the "Determining" Functions
Tr·i,gQ_et·to's *’ codes
ii. A ·‘=` ga- ¤i¤= i A ‘‘‘‘§ -.-=:
=·‘ ‘ In claims 2 and In claim 10, the In cram 12, ln crash 13, the In claim 14,
. ‘`‘'·‘ i =`: A 15, the [criterion] is the [criterion] [criterion] is the [criterion]
__ ___= [criterion] is "included in is "medically "not present in is "mutually
"valid or invalid any other exclusive with the exclusive due
=-= `````` by interacting medical service any other predetermined to non-medical
__..__ _ with the code in the at medical database." criteria with
·` __,_, - database andthe least one claim" service code in (Also, "one of any other
_ -.,. Sat Or the at least one the medical medical
_ ‘ =·` relationships claim" service codes" service code in
·. _ ___- Contained in [hg is replaced by the at least one
.;,,r database" "oiiiy medical cliiim."
:..--= i service code
.· contained.")
Making a Making a Making a Performing a Making a
determination determination determination check to verify determination
‘=i= r__ ,__, ._._ _ `E‘‘ that one ofthe based on the based on the that the based on the
`'`== -=__ medical service relationship relationship medical service relationship
" codes entered on among two of among two or codes input by among two of
'=='=` ’E' i" the claim is the medical more of the the user are the medical
:=: ,;:21 "valid or service codes medical present in the service codes
1 _ _-.- invalid" based entered on the service codes predetermined entered on the
,_E _ -`=· on the database claim, such entered on the database claim, such
.' and the set of relationship claim, such containing relationship
A ‘=/‘ ioioiioooiiiroo based sh ioioiioooiiio oooioo ooo based OH ··hoh-
t oooioiood io iiio whether Ohh bmi im isisiieiiiiiiii- iiiiiiicoi
,,,,, t ,,,,ii,, ititi i titt A oiiiiiioio- code OI1tl1€ Wii<·=iii<=i iis ¤iii¤iii»" iiii
‘ ·‘‘‘ “ ‘·‘- 2 . . entered codes one of the
.,:_., claim rs ,, . . .
2 E::=_._: ,._ Z H, . _, are medically input medical
- ----= ;;;, ,,, ,, ___. included rn . ,, .
, _ ,,,,_,_,, i-ii exclusive, that service codes
A r · ·““°th°’ °°‘*‘°’ °“ she ofthe is
“ __ ; the Claim, [hat input medical inappropriate
==__,_EEE one Qf the mlmt service codes for payment
_,_,,_‘_ medical S=i"~ii<>€ is due to the
___._ Z; °=‘‘:= E E'’` ii _ Qodoo iS _ inappropriate "nonmedical
-_-.-- = i I inappropriate fgy payment Cfit€1'i8·"
1 .'.`.. A for Paymimt dui? to 'ihii
._ _,_. . .i_:_ g. due to such "medically
. "inclusion." exclusive"
‘ ·``‘‘’`' _ relationship.
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Case 1:04-cv—01258-SLR Document 170-2 Filed 12/16/2005 Page 4 of 4
Appendix C: Table Summarizing TriZetto's Constructions
for the "Authorizing" and "Rejecting" Functions
` ````=E``== _ TriZétt0's__QPr0p0se_g]=£g§onst’#u_gpg_gus coded: :‘‘E E::`=
` · ¤=·é EEE:_.__ ` ‘ -E=E :=§E= {fitiil?}g’.Qttitefiiiiilin tu fer :`E‘=
{Faiutit ·-=__ In claim 3,, In Claim ig, In claim 12, In claim 14, In claim 15, these
crit駧§on]: codes [meet codes [meet codes [meet codes [meet elements read:
__ _ {fail} criterion] {fail} criterion] {fail} criterion] {fail} criterion] "means for
=:_ _ __ i ` they "are “HY€ not “HI`€ HOT they “E1I`€ IlOt 3l.,1tl'1OI'lZlTlg
` valid" {"are {are} contained {are} {are} mutually {rejecting} the at
invalid"} in any other medically exclusive due least one claim in
2 '`'`''' ` l - ____:___= i medical service exclusive with to non—medical response to the
code." (Also, any other criteria with 11168.115 {OI
___E= E E:=_ _ '’-.= ni].: ______ these elements medical service any other dete1'miHiHg.”
--E. of claim 10 do codes ITl€diC3l service
=::'' l _.__ H _.__ “ not include the contained in codes
- . language, "in the at least one contained in
. _ response to the claim." the at least one
means for claim."
E.-: EE.; determining?)
Displaying on a Displaying on a Displaying on a Displaying on a Authorizing
tp C0 computer computer computer computer {Rej ecting} for
_==; otherwise _ otherwise I otherwise U otherwise · entire claim
d Q_ -¤·=E= __:-.·]_ [ communicating communicating communicating communicating received from the
_ to a user that to a user that to a user that to a user that user basedon the
· (me or more I one or more one or more one or more . Cl€lI€1“l'I'l1l`l3i1(?1’lS of
; =___· _Q medical service medical service medical service medical service the “determ1ning"
E``; ; _-:.. . eedee input by eedee input by eedee input by eedee input by step-
· the user as part the user as part the user as part the user as part
`"illlill _; E`‘`'`‘. l __ . of a claim of a claim of a claim of a claim
` trrt ‘'‘ _ Shuuld {net} Should {not} should {not} should {not}
==E [ be authorized be authorized be authorized be authorized
an `-'-` _ _ l an fOl` payméfli, i`O1” pHyTIl€l1i, {Of pEiylT1€I1iZ, for pB.yITl€1"ll,
because such because such because such because such
‘ _____ e i`= codes on the codes on the codes on the codes on the
‘·t== e =·-t ’ eteun were eteun were net eteun were net eteuu were net
‘``ii::E:E t-.. = ````E E`i -E-=t.: detennined in {Were} {Were} {Were}
- e_ the determined in determined in determined in
:___ _ an ''`''t . __:= __ i '.=`_ "determining" the the the
=-- Step te be "detenniuins" "detenninins" "detenninins"
`E=—`` I trt . ````= ` i "vetid" Step te be Step te be Step te ue
‘ ‘‘=’ {invalid} inappI’Op1'i3l€ lIli1pPI'OPi`l€lt€ inappropriate
____=_ an l _____ .j.:·. for payment for payment for payment
=·-- beg ause they due to tht? due to the
=_= __ were not “medically "non—medical
" {were} exclusive" criteria."
.:=`..·. "included in" relationship.
=_. _ on the claim.
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