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Integration helps Rocky Mountain Health Plans increase efficiency in requesting, processing, and reporting prior authorizations
SEATTLE, June 25, 2014 /PRNewswire/ -- MCG (formerly Milliman Care Guidelines and now part of the Hearst Health network) has integrated its Cite® AutoAuth Module with the Essette® Web-based Care Management platform. This collaboration automates prior treatment authorization in existing workflows, combining rapid evidence-based utilization decisions with self-service simplicity to drive inquiry responses in seconds rather than days.
"Integrating MCG's AutoAuth Module gives Essette the power of guiding users through evaluating clinical necessity while creating a prior authorization or performing inpatient review," said Essette CEO Andy Gaudette. "We consider MCG as the 'best in breed' not only from an evidence-based guidelines standpoint, but also as an integration partner."
Cite AutoAuth Module links relevant MCG Care Guidelines and payor rules to predetermined procedure and admission authorization requests and automatically processes those requests, approving or routing for further review as appropriate. Clients agree that the integration provides significant added value in their operations.
"Rocky Mountain Health Plans has seen increased efficiencies in requesting, processing, and reporting on our prior authorizations by using the MCG and Essette integrated products," said Sandy Dowd, Case Management Director with Rocky Mountain Health Plans. "Both organizations have worked with us to meet our specific business needs around prior authorizations. They have evolved standard functionality to create processes that work well for our providers and our staff."
Essette's flexible technology platform, combined with MCG's AutoAuth rules engine and the most comprehensive and trusted evidence-based clinical guidelines in the industry, delivers multiple benefits for providers. They experience easy-to-use clinical data entry and effective workflows that generate rapid responses to authorization approval inquiries.
"Essette is a cornerstone in our partner alliance program, and we are enthusiastic about working with them to extend added value to clients, in terms of both efficiency and quality, through this integration," said MCG President Jon Shreve.
With this combined resource at their fingertips, providers and their staff are quickly guided through qualifying question-and-answer sessions, allowing them to interact directly with health plans and, as a result, deliver direct responses to the patient-increasing both provider and patient satisfaction.
"We hear nothing but 'WOWs' from clients who witness how truly integrated MCG's guidelines are into Essette's workflow," Gaudette said.
Improved health and lowered costs require an integrated approach. One that's flexible, affordable and promotes care across the continuum. Essette® (pronounced eh-SET) web-based care management software offers a robust alternative to 'shrink wrapped' applications. Incredibly powerful and user-friendly, Essette software-built upon a refreshingly efficient platform-is rapidly becoming the preferred choice for healthcare organizations seeking a simple means of delivering high-value, collaborative care. Whether the need is for real-time monitoring and reporting of data, interface ability with "core systems", analytics, exchanges, and external EMRs, or the added expertise of our Clinical Consultants, Essette is committed to providing its clients with integrated solutions that combine technology with creative thought and integrity. Learn more about EssetteCM, Essette PM, EssetteUM, and Essette's other simple software solutions by visiting www.essette.com, or through firstname.lastname@example.org.
About Rocky Mountain Health Plans
Founded in 1974 in Grand Junction, Colorado, Rocky Mountain Health Plans (RMHP) is an independent, not-for-profit health insurance provider, who uniquely understands the needs of Colorado and the people who live here. We provide access to affordable, quality health care enabling our more than 220,000 Members to live longer, healthier lives, while maintaining our mission to put people before profits. Rocky Mountain Health Plans is the only health plan in Colorado to serve every market segment, including individuals, families, employers, Medicare, Medicaid, and Child Health Plan Plus beneficiaries. Rocky Mountain Health Plans is 1 of only 2 health plans to receive a 5 star quality ranking on the Colorado health exchange, Connect for Health Colorado, and our Medicare plans have received a 4 ½ star rating from the Centers for Medicare and Medicaid Services (CMS). The National Committee for Quality Assurance (NCQA) recently awarded Rocky Mountain Health Plans a commendable status for continuously improving the quality of care and services provided to Members. For more information, visit rmhp.org or connect with RMHP on social media @RMHPColorado on Facebook, @RMHP on Twitter, @rmhpColorado on Pinterest, and @rmhpcolorado on Instagram.
MCG, formerly Milliman Care Guidelines and now part of the Hearst Health network, independently develops and produces evidence-based clinical guidelines and software used by more than 2,200 clients, including 1,200 hospitals and 8 of the 10 largest U.S. health plans. Updated annually by an experienced team of clinicians, the care guidelines support the care management of a majority of Americans. For more information, visit www.careguidelines.com (http://www.careguidelines.com).
The Hearst Health network also includes FDB (First Databank), Zynx Health, and Homecare Homebase. The mission of the Hearst Health network is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person's health journey. To learn more about the Hearst Health network, please read the Hearst press release (http://www.hearst.com/newsroom/hearst-corporation-introduces-hearst-health).
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