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Essette Appeals and Grievances

The only integrated platform in the business dedicated to appeals and grievances processes.

Appeals and grievances are elements of your plan that are critical to get right. Without efficient workflows and clear communication, it’s all too easy for costs to rise, compliance to falter, and relationships with members and providers to sour. But there is another way.

That’s why we created Essette Appeals and Grievances. It remains the best web-based product for handling every type of appeal/grievance under the sun.

The user-friendly solution empowers your team with configurable workflows and content to efficiently manage all lines of business and case types: health plans, Medicaid, Medicare, member, provider, authorization denials, payment issues, quality of care concerns, and more.

Essette Appeals and Grievances use a simple graphical interface to guide users with step-by-step tasks. Dashboards provide a clear overview of, and quick access to, all cases and tasks assigned to a user. A built-in and user-friendly report designer allows standard and ad-hoc reporting. For instance, you can set up rules to require two reviews of a letter before sending to a patient or provider – all dependent on the line of business and case type.

Tight integration with Essette Utilization Management means case workers have all relevant authorizations and claim information at their fingertips, along with access to correspondence, notes, and attached documents. Cases can be routed to other internal or external individuals and compliance teams, all from this central hub.

Think of it: no more spreadsheets and correspondence systems that live outside of the platform. Only Essette Appeals and Grievances brings everything and everyone together.

The results? Reduced operating costs, improved provider and member satisfaction, and higher compliance and quality scores.

Contact HMS today to see how Essette Appeals and Grievances can make a difference for you.