Federal Services

The Veterans Benefits Administration (VBA) disability medical examination, also known as a VA Claim Exam or C&P exam, (compensation and pension exam) is a medical assessment that helps determine the severity of a veteran’s disability and whether it’s service-connected. The exam is part of the VA’s claims process and addresses the Veterans’s request for benefits. Dane Street’s national coverage of qualified credentialed physicians assists in performing these in-person visits at our locations or locations associated with the VA. The focus is on speeding care and benefits to the veteran and to provide a high level of service and fast turnaround time. Dane Street’s physician panel is fully credentialed and has completed specific VA examination training.

Dane Street offers comprehensive support to the health plans, pharmacy benefit managers (PBMs), and both state and federal entities, including Medicaid, Medicare, ACA Exchanges, and Duals programs. Our services encompass Prior Authorization Initial Reviews and specialty-matched Appeal Reviews, designed to enhance the Utilization Management (UM) process. We are committed to maintaining rigorous clinical oversight to ensure consistent documentation and adherence to guidelines across all determinations. With extensive experience in clinical review and a foundation in peer-reviewed literature, Dane Street upholds the highest standards of service.

Dane Street is a URAC-certified and NCQA-accredited Independent Review Organization (IRO) that services Health Plans, Pharmacy Benefit Managers (PBM), Third Party Administrators (TPA), Self-Administered Employee Benefits Groups, Utilization Management (UM) Organizations, and Government Agencies nationwide. We can support nurse/pharmacy tech and pharmacist level reviews, generalist and specialty match Prior Authorization reviews, Appeal Review Services, and External Reviews across all lines of business, including Commercial, Pharmacy, Medicaid, Medicare, Duals and Marketplace for Medical, Behavioral Health, and Dental.

The Independent Dispute Resolution process emanated from the No Surprises Act, a consumer protection legislation designed to protect individuals (through their insurers, medical providers, or hospitals) from receiving unexpected high-dollar medical bills. Health Plans that fall under the NSA provisions include group health insurance plans, Federal Employees Health Benefits Program (FEHB), and health insurance carriers. The program addresses charges in three areas: air ambulance services, high-dollar emergency room services, and out-of-network facility charges.

OWCP requires Independent Medical Examinations or Second Opinion Medical Examinations as well as Functional Capacity Exams to ensure that workers on Federal programs are receiving the right care and that the treatments are appropriate for the diagnoses that the injured worker has received are appropriate. Our services address key issues such as causation, treatment recommendations, and evaluations of physical impairment for Permanent Partial Disability (PPD) or Permanent Total Disability (PTD) after Maximum Medical Improvement (MMI) has been reached.

Dane Street specializes in Independent Medical Examinations (IMEs) and Record Reviews for Federal claims under the LHWCA, including its related statutes such as the Jones Act, Defense Base Act, and Federal Employees’ Compensation Act. Our services address key issues such as causation, treatment recommendations, and evaluations of physical impairment for Permanent Partial Disability (PPD) or Permanent Total Disability (PTD) after Maximum Medical Improvement (MMI) has been reached.

Dane Street provides second opinion examinations and medical review services with indepdent, board certified physician specialists designed to assist carriers, self-insured entities, third-party administrators, and government agencies in clarifying work-related conditions, assessing disability extent, determining work capacity, and addressing other critical issues for expedited and accurate claim resolution.