Intelligent automation lets you do more with less.
The shift from fee-for-service to value-based care has made it more important than ever for payers to offer patients high quality, cost-effective care. HMS Essette Utilization Management supports the appropriate utilization of services. The tool helps customers increase efficiency, meet specific business requirements, and react quickly to changing market and regulatory challenges.
HMS’s powerful web-based solution provides organizations with the actionable intelligence needed to make timely, cost-effective determinations. How? Essette Utilization Management utilizes an auto-approval rules engine that tightly integrates with evidence-based guidelines. Our highly-automated configurable workflow allows you to adopt an authorization process designed to save time, reduce error, monitor cost and quality requirements, and meet the stringent compliance standards set by the Centers for Medicare and Medicaid Services (CMS). The workflow includes diagnosis and service flags for codes that require particular attention.
True, seamless integration with evidence-based guidelines, including those offered by McKesson InterQual®, MCG’s Auto Auth module AAM®, and MCG’s CareWebQI®, means that you can continue to utilize your existing decision management solutions. These guidelines at the fingertips of your utilization management team ensure a patient’s length of stay and level of care match clinical necessity, and optimizes the concurrent or inpatient review process. Integration with your claims system ensures that claims are paid based on approved authorizations.
Authorization queues allow collaboration with other departments and groups, while configurable notes mean everyone working on the case has access to all pertinent information. Our easy-to-use interface ensures uncluttered screens which only display fields relevant to the current user. Seamless care transitions are assured by tight integration with our care and population management modules, and a compliance clock makes sure all regulatory deadlines are met.
When Essette Utilization Management is combined with Essette Care Management, you can elect utilization management representatives to become part of their integrated care team, or can simply designate nurses to process their own authorizations.
Automated delivery of regulatory letters to members and providers is another time-saving advantage offered by Essette Utilization Management. Our powerful correspondence tool provides an easy-to-use, flexible solution for capturing both regulatory and business rules. As a result, customers who adopt Essette Utilization Management are able to quickly create automated correspondence that meets their unique business requirements. With Essette Fax Management, faxes from dedicated lines can be loaded directly into configurable queues; no more logging into separate fax software. Faxes can be attached to existing authorizations or be used to create new authorization cases.
Essette Utilization Management enhances relationships between plans and providers. Identifying clinical necessity before a claim is submitted reduces potential provider friction. Another plus for providers is integration with HMS’s Essette Provider Portal. This tool gives you the ability to manage your authorization requests and referrals electronically, using a real-time-view dashboard.
Do more with less, with HMS Essette Utilization Management.
Fill out the contact form and let us help you streamline your utilization management.