Government Medicaid Utilization Management

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.

Our network of providers covers 120 specialties throughout the country. In addition, to our providers, the Dane Street Quality Assurance nurses provide upfront analysis and oversight to ensure rapid turnaround time and appropriate application of various customers’ protocols and guidelines or policy benefits.