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We provide the Department of Health & Human Service agencies clinical review services addressing Medicaid benefits coverage issues requiring highly complex and technical decisions. We also provide expert reviews for Medicaid Preferred Drug List ratification to guarantee that Medical Assistance (MA) program beneficiaries community Managed Care Organization systems receive clinically effective pharmaceutical care, focusing on quality, safety, and optimal outcomes from prescribed medications.
Dane Street is nationally accredited IRO contracted with the Department of Insurance in multiple states throughout the country to support State External Reviews for final binding Appeal determinations for group health insurance plans and health insurance issuers offering coverage in the group and individual markets. Dane Street handles notification letters and determinations to all parties within the state regulated timeframes.
Dane Street conducts thorough reviews of state-mandated appeals concerning the medical appropriateness of care provided to individuals injured in auto accidents. This process involves evaluating the necessity and effectiveness of the medical treatments received by these injured workers, ensuring compliance with state regulations and standards for appropriate care.