We have a custom built OnCall listing app built on remedy, where people can 
edit the oncall information related to their groups, they also have the 
ability to set start date and end date for oncall rotation. Our NOC will use 
that oncall list to make manual calls to them if a critical ticket is not 
set to Work In progress within 15 min.
Apart from that we have an integration with TelAlert to start the alerting 
when a critical/high ticket is created to a support group.
Rules  around alert escalation are built inside TelAlert to send  alerts to 
Oncall Primary,  and after 15 min if the ticket is still not in WIP then to 
oncall seconday and then to Manager etc..
Upon ticket creation remedy does a runprocess command with ticket number and 
support group to tell TelAlert to start sending alerts.
Upon ticket is resolved/reduced priority we have another runprocess command 
to TelAlert to stop sending alerts.
We have created outlook mms-mailboxes for each support group, which telalert 
uses to send alerts upon a signal from remedy.

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