Appeals
A written rationale for a contested decision.
When a utilization decision is appealed, plans and TPAs need an outside clinical record they can stand behind. ArkMedis writes that rationale. We do not replace the plan’s appeal unit or its lawyers.
What the file needs
- The decision being appealed and the clinical question
- The record the reviewer is allowed to consider
- The plan or TPA pathway the rationale has to fit
- A specialty we can actually staff
Scope is confirmed before records move. The shorter solution note is on Appeals support.
What you receive
- Independent clinical review under Medical Director oversight
- Conflict-of-interest screening documented for the file
- Written rationale suitable for the plan’s own process
- A decline, if the question is outside what we can staff
Who this is for
- Health plan medical directors and appeal teams
- TPAs handling a book of business
- Self-funded sponsors who need the plan’s reviewer identified
Treating providers are not the client on these files. See For providers.
Boundaries
- Not attorney representation and not a hearing appearance
- Not a certified-IRO or accreditation claim
- Not workers’ compensation appeals
- Not a promise of a particular appeal outcome
- Not a published turnaround percentage
Questions
Is ArkMedis the external review organization for my state?
Do not assume that. We do not publish a license map and we do not claim authority to perform external review in every state. Texas IRO certification is not active. The status callout is on For payers.
What do you actually deliver on an appeal?
An independent clinical review and a written rationale the engaging plan or TPA can carry in its appeal process. The clinical question is usually medical necessity.
Will you argue the case as counsel?
No. We are not a law firm. Legal services, attorney staffing, and representation at hearing are not offered. The plan’s own counsel remains counsel.
Which specialties can you staff for an appeal?
As of September 2026, Internal Medicine is Available. Other specialties are Building. We decline an appeal question we cannot match.
Do you handle workers’ compensation or Medicare Advantage dispute programs?
Workers’ compensation appeals are not offered. We also do not market a federal independent-dispute or CMS IDR product. Confirm any other program scope in writing before a file is sent.
Start with the question being appealed.
Tell us the clinical question and the specialty in a non-PHI note. Records stay off email and fax.