Workers’ Compensation

Dane Street provides Workers’ Compensation IMEs, Physician Advisor Reviews, Peer Reviews, and Pharmacy Reviews to Tier 1-4 carriers, Managed Care Organizations, Third-Party Administrators, Utilization Review Organizations and Employers. We are licensed in all mandatory UR states, and have an active Regulatory and Compliance group which interfaces with the appropriate state Workers’ Compensation boards and departments of insurance.

We understand the importance of state-specific medical treatment guidelines, turnaround times, match requirements—and track any changes across these categories in our rules-based AccessDS platform. Dane Street can work with your internal UR team, your URO partner and field claims examiners to handle all of your Initial Reviews, Appeals and Addendums. Our Workers’ Compensation services include the following:

• Specialty match options
• State matching where required/requested
• Access to Dane Street’s entire national network of physician advisors
• Uploading and storage of documents in Dane Street’s AccessDS platform
• Peer-to-Peer outreach to treating physicians where requested
• Sorting and labeling by Dane Street intake team
• QA review by Dane Street nurses and claim specialists on 100% of referrals
• Quarterly business reviews with Dane Street AM team, clinical manager and medical director
• Reviews delivered according to all URAC, jurisdictional and client requirements

For complex medication cases looking for assistance beyond medical necessity and appropriateness, Dane Street’s Pharmacy Reviews offer a more robust drug utilization review, including a detailed breakdown by medication and go-forward treatment plan. These reviews are performed by a highly specialized group of Pain Management/PM&R/Internal Medicine specialists who are adept at conducting peer-to-peer conversations with treating providers to assist in:

• Determining what medications are appropriate or not
• Determining what medications are related or not
• Weaning off, tapering, and discontinuing unrelated and/or inappropriate medications
• Ensuring pharmacological management is consistent with appropriate guidelines, including ODG, ACOEM, MTUS, AAPM, etc.
• Staying up-to-date with the most relevant industry practices and other State-Specific Guidelines
• Working with the prescribing physicians to transition from a less-than-optimal to an optimal treatment plan