Utilization review
Independent review of a utilization question.
Health plans and TPAs use ArkMedis when they need an outside clinical look at a utilization decision. We review the record we are given and write a rationale. We do not run the plan’s UM shop.
Medical necessity
- The clinical question, stated before the file is accepted
- Review against the record and applicable standards of care
- Written rationale meant to sit in the plan file
- No volume targets and no outcome incentives
Appeal-ready documentation
A utilization review that may be contested needs a rationale the plan can carry forward. Appeals support is that written record. It is not a claim that ArkMedis is the external-review agency in every state.
Who does the review
- Medical Director oversight by Dr. Yougandhar Akula, board-certified in Internal Medicine
- Specialty match limited to coverage we can actually staff
- Internal Medicine Available; other specialties Building
- Documented conflict-of-interest screening on the file
How a file moves
- Non-PHI introduction and scope check through Contact
- Conflict screening before clinical work
- Records only through the portal, from an authorized user, when that intake path is open
- Written rationale back to the engaging plan or TPA
Timelines are set on the file. The step list is on How we work.
Outside this service
- Plan UM operations and nurse staffing
- On-demand medical director placement
- A UM or peer-review software product
- Workers’ compensation utilization review
- A license map covering every state
- Accreditation seals we do not hold
Questions
Are you the plan’s utilization management department?
No. ArkMedis is an outside reviewer. We do not supply UM nurses, prior-authorization operations, or day-to-day plan staffing.
Which clinical questions do you accept?
Medical necessity and related utilization questions, scoped before a file is accepted. As of September 2026 we can staff Internal Medicine. Other specialties are Building. We decline a question we cannot match.
When does review processing start?
Texas IRO certification is not active. The status callout lives on For payers. Case upload follows the portal rules on this deployment, and review processing follows certification.
Do you guarantee a turnaround time?
No. Standard or rush handling is confirmed at intake for that file. We do not publish an hour clock or an on-time percentage.
Is there a utilization-management software product?
No. See Software. The portal is a case workspace for authorized users, not a UM platform for sale.
Describe the utilization question first.
Contact is for scope, specialty, and timing. Do not send the clinical record by email or fax.