Group Health

Dane Street provides independent medical peer reviews that assist top US leading health plans, TPAs, Pharmacy Benefit Managers, Self Administered Employee Benefit Groups, Utilization Management Organizations and Government agencies in delivering medically appropriate care, while controlling healthcare costs and increasing member satisfaction.

Our nationwide physician panel is led by two Medical Directors with deep health plan experience that play a vital role in physician panel oversight. Our physician panel expertise specializes in providing determinations for medical necessity, plan language, experimental investigational services and standard of care.

Listed below is a summary of the markets we serve and the type of work we currently manage for our clients:

Markets

  • Behavioral Health
  • Commercial
  • Medicare/Medicaid
  • Federal Employee Programs
  • Pharmacy

Referral Types

  • Initial Reviews
  • Appeals
  • Coverage Determinations & Exceptions (inpatient and observation)
  • Federal External Reviews
  • State Level IRO Reviews
  • Clinical Risk Reviews
  • Policy Guideline Reviews

Our Health Plan panel is comprised of 600+ board certified and active practice physicians across 80+ specialties. Our coverage includes top requested specialties such as Hematology, Oncology, Dermatology, Otolaryngology, Cardiology, Psychiatry and Psychology. We also provide coverage for hard-to-find specialties such as Radiation Oncology, Pediatric Specialists, Genetic Testing specialists and specialists in ABA Therapy.

Our Clinical Quality Assurance team reviews 100% of all cases prior to client delivery, and our Operations team is adept at handling standard, rush and expedited timeframes. Dane Street also provides weekend and holiday coverage. Clinical auditing tools are utilized for the assessment of decisions made by all clinical advisors and on-going training is provided where there is identification of a potential need for improvement.

In addition, for many clients, we handle specific UM delegated tasks such as the provision of Member Friendly Rationales. Dane Street is able to meet the NCQA Readability requirement using Flesch Kinkaid for all our clients.

Dane Street partners with our clients closely around Delegation Audit Oversight (led by our Regulatory and Compliance team) and delivers detailed monthly outcome reports.

For More Information or To Reach Our Group Health Team, Contact Us Here
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Independent Review Organization: Comprehensive Review (Internal & External) 06/01/2025
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Workers' Compensation Utilization Management 06/01/2025
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