Integrated HIPAA-compliant computer security system for authorizing, documenting, verifying, billing and adjudicating long term services and supports, including individual budgeting
Systems and methods for sharing billing information across at least two organizations in an integrated manner are described. A physical node may receive a request for authorization for a user in an organization to access an individual's information in another organization. The request may be logged. The physical node may determine whether the user is authorized to access the individual's information and, if it is, provide appropriate access. Also disclosed is an integrated web application and system which includes the core plan, budget, service authorizations, service documentation, claims, and communications of an individual under care and allows for calculated access and communication with external authorization and payment systems.
1. A HIPAA-compliant computer security method of sharing service, budget, and billing information associated with personal health information of one or more individuals among at least a first organization and a second organization in an integrated manner, and preventing unauthorized access to the billing information, the method comprising:
a. receiving by one or more physical nodes a first request for authorization for a user in the first organization to access service and budget information in the second organization pertaining to personal health information of one or more individuals, wherein the first organization is associated with a first security domain, the second organization is associated with a second security domain, the second organization has an access profile associated with the first security domain, the user is associated with one or more roles and one or more caseloads, the service and budget information for each of the one or more individuals having at least one type, the one or more roles includes access privilege information for one or more users, and the one or more caseloads includes access privilege information for at least one individual or medical services program associated with said individual's personal health information;
b. logging by the one or more physical nodes, in an activity log associated with at least the first organization or the second organization, the user's first request for authorization for the user in the first organization to access service and budget information in the second organization pertaining to the one or more individuals;
c. determining by the one or more physical nodes whether the user in the first organization is authorized to access service and budget information in the second organization pertaining to the one or more individuals, wherein the determination is based on at least the access profile, the one or more caseloads and the one or more roles associated with the user and the type of service and budget information in the second organization pertaining to the one or more individuals and associated with said individual's personal health information;
d. responsive to determining that the user in the first organization is authorized to access service and budget information in the second organization pertaining to the one or more individuals:
i. transferring by the one or more physical nodes the service and budget information in the second organization pertaining to the one or more individuals in compliance with HIPAA, and;
ii. logging by the one or more physical nodes, in the activity log, the transferring of service and budget information in the second organization pertaining to the one or more individuals to the user in the first organization in compliance with HIPAA; and
responsive to determining that the user in the first organization is not authorized to access service and budget information in the second organization pertaining to the one or more individuals, preventing the requested access in compliance with HIPAA; and
e. receiving, by one or more physical nodes, information pertaining to services provided to the one or more individuals by the first organization and billing information generated by the first organization pertaining to the provided services.
2. The method of claim 1 , further comprising the step of establishing a budget and service plan for the one or more individuals.
3. The method of claim 1 , wherein the second organization provides a service authorization to the first organization prior to step (a).
4. The method of claim 1 , further comprising step (f) of generating claims for payment from the information pertaining to billing for services provided to the one or more individuals.
5. The method of claim 4 , further comprising step (g) of submitting said claims for payment to at least one payor.
6. The method of claim 1 , wherein the user is a doctor, health care professional, case manager, or staff person of the first or second organization.
7. The method of claim 1 , wherein the first organization is an independent provider.
8. The method of claim 7 , wherein the independent provider is a user providing non-specialized services.
9. The method of claim 1 , wherein the one or more physical nodes include one or more computers.
10. The method of claim 1 , wherein the one or more physical nodes are at least two physical nodes that are not identical and operate independently of each other.
11. The method of claim 1 , wherein the one or more physical nodes include one or more storage arrays.
12. The method of claim 1 , wherein the one or more physical nodes include one or more physical disc drives.
13. A HIPAA-compliant computer security system for sharing service, budget, and billing information associated with personal health information of one or more individuals among at least a first organization and a second organization in an integrated manner, and preventing unauthorized access to the billing information, the system comprising:
a. means for receiving by one or more physical nodes a first request for authorization for a user in the first organization to access service and budget information in the second organization pertaining to personal health information of one or more individuals, wherein the first organization is associated with a first security domain, the second organization is associated with a second security domain, the second organization has an access profile associated with the first security domain, the user is associated with one or more roles and one or more caseloads, the service and budget information for each of the one or more individuals having at least one type, the one or more roles includes access privilege information for one or more users, and the one or more caseloads includes access privilege information for at least one individual or medical services program associated with said individual's personal health information;
b. means for logging by the one or more physical nodes, in an activity log associated with at least the first organization or the second organization, the user's first request for authorization for the user in the first organization to access service and budget information in the second organization pertaining to the one or more individuals;
c. means for determining by the one or more physical nodes whether the user in the first organization is authorized to access service and budget information in the second organization pertaining to the one or more individuals, wherein the determination is based on at least the access profile, the one or more caseloads and the one or more roles associated with the user and the type of service and budget information in the second organization pertaining to the one or more individuals and associated with said individual's personal health information;
d. means for responding to a determination that the user in the first organization is authorized to access service and budget information in the second organization pertaining to the one or more individuals said means comprising:
i. means for transferring by the one or more physical nodes the service and budget information in the second organization pertaining to the one or more individuals in compliance with HIPAA; and
ii. means for logging by the one or more physical nodes, in the activity log, the transferring of service and budget information in the second organization pertaining to the one or more individuals to the user in the first organization in compliance with HIPAA; and
means for responding to a determination that the user in the first organization is not authorized to access service and budget information in the second organization pertaining to the one or more individuals by preventing the requested access in compliance with HIPAA; and
e. means for receiving, by one or more physical nodes, information pertaining to services provided to the one or more individuals by the first organization and billing information generated by the first organization pertaining to the provided services.
14. The system of claim 13 , further comprising a means to establish a budget and service plan for the one or more individuals.
15. The system of claim 13 , further comprising a means for providing a service authorization to the first organization.
16. The system of claim 13 , further comprising a means for generating claims for payment from the information pertaining to billing for services provided to the one or more individuals.
17. The system of claim 13 , further comprising a means for submitting said claims for payment to at least one payor.