The role
Health plans and administrators decide whether a service is covered or medically necessary. An independent review organization is a separate clinical reviewer. The point of the separation is that the people who issued or defended the decision are not the only people reading the record.
A useful review says what question was asked, what record was considered, which specialty read it, and what the clinical rationale was. It is not a marketing statistic.
What an IRO is not
- Not the member’s treating physician
- Not the plan’s law firm and not a substitute for counsel
- Not a workers’ compensation network, an IME vendor, or a PBM
- Not, by itself, a government contractor, a Medicare reviewer, or a federal independent dispute resolution entity
State external-review programs, ERISA appeal rules, and other regulatory paths differ. Whether a particular file must go to a particular kind of reviewer is a legal and plan-document question. ArkMedis does not answer that question on a marketing page.
How ArkMedis uses the term
ArkMedis is an Independent Review Organization serving health plans and TPAs across the United States. The primary office is in Houston. FabCare LLC does business as ArkMedis. The organization is physician-owned and for-profit. It is not a nonprofit and it does not claim a heritage date or a case-volume milestone.
Texas Department of Insurance IRO status is applicant. We do not say “certified IRO.” We do not display URAC, HITRUST, NCQA, NAIRO, or SOC 2 seals. Holding HIPAA business associate agreements with Google Workspace and Google Cloud does not change those facts, and it does not mean case PHI is accepted today.
Specialty coverage is intentionally short: Internal Medicine is Available; other specialties are Building. See Specialties and How we work.
Where records go
They do not go here. Public email and fax are administrative. The portal is the intended future path for PHI and it is not open. Read how PHI is handled and Security & Trust.