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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.
In addition to Prior Authorization Medical Director Reviews and Appeal Review Services, Dane Street also supports our clients with Medical Policy Guideline Reviews and Quality Risk Review Services based on the standard of care as well as DRG Validation Reviews and Integrity Dispute Claims Reviews.
Our Health Plan/PBM Physician Panel is composed of over 1,000 board-certified and active-practice physicians across 120 specialties. Our coverage includes top requested specialties such as Hematology, Oncology, Dermatology, Otolaryngology, Cardiology, Psychiatry, and Psychology. We also provide coverage for hard-to-find specialties such as Radiation Oncology, Pediatric Specialists, Genetic Testing specialists, and specialists in ABA Therapy.
Our Quality Assurance Team reviews 100% of all cases before the determination is submitted. Clinical auditing tools are utilized for the assessment of determinations made by our clinical advisors and ongoing training and oversight are provided to ensure the highest quality is maintained.
Our Operations Team is adept at meeting standard, rush, and expedited timeframes. Dane Street provides weekend and holiday coverage. In addition, for many clients, we handle specific UM delegated tasks and partner closely with our clients around Delegation Oversight requirements led by our Regulatory and Compliance Team.
Please see a listing of our service offerings below:
