Dane Street offers Peer Review (i.e., Record Review; File Review) services to assist our Workers’ Compensation, Auto, and Disability clients’ teams around claims requiring an expert, independent opinion around the necessity and appropriateness of care, causality and relatedness. Peer Reviews are paper-based evaluations, conducted by our licensed and credentialed Peer Review panel of physicians.
Referrals may be prospective, concurrent, or retrospective in nature and can center around a single medical event, or multiple incidents of care. Dane Street’s process involves an in-depth review of each client’s questions and an extensive review of the associated medical records and clinical information. All decisions are made utilizing evidence-based guidelines, where applicable, and in accordance with state-specific content and turnaround time requirements.
Peer-to-Peer outreach is a standard component of Peer Reviews, although clients can specify at a program level—or on a case by case basis—their desired peer-to-peer protocol. Dane Street’s reviewers make multiple outbound telephone calls to the treating provider(s) in an attempt to discuss the case in a collegial manner and to render the appropriate determination based on the records reviewed, evidence-based guidelines and treating provider discussion.
Typical turnaround time for Peer Reviews is 3-5 days on average, with variances due to the number of questions, the size of the medical records and the complexity of the case. 100% of cases are Quality Assured by Dane Street’s team of claims and clinical resources, with QA teams segmented by line of business to ensure the report addresses all of the requestor’s questions and is supported by a clear and compelling rationale.