Group Health

Dane Street provides group health peer review services to group health plans, health and wellness plan providers, TPAs, and self-funded employer groups. Our independent review services comply with all requirements for performing reviews associated with the Patient Protection and Affordable Care Act (PPACA) and PHI, including new turnaround times and managing communications to the member and plan. As a URAC-accredited Independent Review Organization, we ensure that our reviews are free of any conflict of interest. Dane Street ensures objective and consistent medical necessity analysis with all review decisions.

Inter-rater Reliability tools are utilized for the assessment of decisions made by all clinical advisors and training is provided where there is identification of a potential need for improvement. Clinical advisors join our panel only after obtaining the Dane Street Credentialing Committee’s approval following a rigorous review of the candidate’s credentials. Thereafter, Dane Street monitors all US jurisdictions on a monthly basis to assess for potential ongoing development of sanctions for clinical advisor panel members.

Dane Street provides two primary types of review: Utilization Review and Quality of Care reviews to our clients. Deliverables include:

  • Specialty match options
  • State matching if required/requested
  • Access to Dane Street’s entire national network of physician advisors
  • Uploading and storage of documents in Dane Street’s AccessDS platform
  • Peer-to-Peer outreach to treating physicians where requested
  • Sorting and labeling by Dane Street intake team
  • QA review by Dane Street RN on 100% of referrals
  • Reports delivered in client-specific template
  • Reviews delivered according to all URAC, federal, state and client requirements