Scope
When a utilization decision is contested, ArkMedis can provide an independent clinical review and a written rationale the plan or TPA can carry in its appeal process. The clinical question is usually medical necessity. See Medical necessity review.
What this page is:
- External clinical review support for plan and TPA appeals
- A documented rationale, after conflict-of-interest screening
- Specialty match under Medical Director oversight, limited to what we can actually staff
What this page is not:
- A claim of “certified IRO.” Texas Department of Insurance status is applicant only.
- A claim of URAC, HITRUST, NCQA, NAIRO, or SOC 2.
- A license to perform external review in states where we do not hold that authority. We will not imply a national license map.
- Workers’ compensation appeals, IME, CMS independent dispute resolution, Medicare contractor work, or QIC review.
Evidence we need
Do not send records to this website, to email, or to fax. When the vault is live, an appeal file typically needs:
- The decision being appealed and the clinical question
- The record the plan relied on, plus any new clinical material
- The applicable criteria, if the plan wants them applied
- Appeal correspondence that frames what is in dispute
Secure case upload is available for authorized portal users (Business, Provider, and Admin) after MFA: a verified email and a second factor, with an authenticator preferred and US SMS supported. ArkMedis will review and process submitted cases after Texas Department of Insurance Independent Review Organization certification is issued. The application is filed and in process. Certification is not active. Send case PHI only through the portal vault. Do not send PHI by email or fax. Download of stored files is not available yet. See the portal.
Reviewer matching
The reviewer should match the question, not a generic queue. Internal Medicine is Available as of September 2026. Other specialties are Building. We do not assign a case we cannot staff, and we do not invent panel depth to win an appeal contract.
Independence
Appeal support is still independent review. Physician ownership, MD Medical Director accountability, documented conflict screening, and a written rationale apply. We are not paid to reach a particular outcome. Process detail is on How we work.
This explanation is operational, not legal advice. Whether a given appeal requires a particular state external-review pathway is a question for the plan’s counsel and the applicable regulator.
Turnaround
Appeal clocks belong to the plan’s process and the file in front of us. ArkMedis confirms standard or rush handling at intake. We do not publish hour-based service levels or a percent of appeals completed “on time.”