Scope
ArkMedis reviews whether a requested or provided health service meets medical necessity for a health plan, TPA, or self-funded sponsor. The work product is an independent clinical determination with written reasoning.
In scope today as a service we will perform once a file can be accepted:
- Medical necessity and related utilization questions
- Specialty-matched review — Internal Medicine Available; other specialties Building
- Determinations meant to sit in a plan or appeal file. See also Appeals support
Out of scope: workers’ compensation review, independent medical examinations (IME), PBM or pharmacy-benefit review, LTD or disability review, payment integrity, and CMS independent dispute resolution. We do not claim URAC accreditation or “certified IRO” status. Texas TDI IRO status is applicant only.
Evidence we need
Do not email or fax this material. 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.
- The clinical question and the service under review
- Relevant medical records and imaging or test reports
- Plan criteria, if the plan asks us to apply them
- Any prior adverse determination or appeal correspondence
None of the above goes to admin@arkmedisreviews.com or to fax 832-678-7069. Those channels are non-PHI administration only. See Security & Trust.
Reviewer matching
Cases are routed to a clinician whose specialty aligns with the question, under MD Medical Director oversight. We do not publish a specialty count or a finished national panel. If we cannot staff the question, we say so at intake.
Independence
Physician-owned organization. Documented conflict-of-interest screening before clinical work. No volume targets and no outcome incentives. The determination is written. Quality review checks specialty fit and completeness before it is final. The path is on How we work.
Turnaround
Standard and rush are process choices, not a public clock. The timeline is confirmed at intake after we know the question is one we can accept. We do not publish hours, day guarantees, or percent complete.