Who this is for
Employers and plan sponsors who fund their own health benefits and need an independent clinical opinion on medical necessity or an appeal. Many arrive through a TPA. The sponsor still needs documentation that is not written by the party under review.
- Fiduciary process is easier to explain when the reviewer is outside the plan and outside the TPA’s medical staff.
- Savings stories and “average overturn” rates are easy to invent and hard to defend. We do not publish them.
- Member records are PHI. They do not go to a public inbox while the case vault is closed.
- Accreditation seals are not a substitute for a written rationale. We do not display seals we have not earned.
What ArkMedis does for you
- Medical necessity review of the service in question, matched to specialty as honestly described on Specialties.
- Appeal support with the clinical reasoning in writing.
- Conflict-of-interest screening and Medical Director oversight on the path described in How we work.
- Coordination with your TPA when that is how the plan operates. See TPAs.
We are not the plan’s law firm, stop-loss carrier, or treating providers. We do not claim a current government contract. Workers’ compensation, IME, PBM, and LTD review are not products we sell.
How intake works
Introduction without member detail
Contact can cover who the plan sponsor is, whether a TPA is involved, and the kind of review you need. Leave member names, claims numbers, and clinical facts out.
Engagement, then timing
After scope is clear, standard or rush handling is confirmed per file. There is no public clock and no completion-rate claim.
Records go through the portal
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.
Independence and conflict of interest
A self-funded sponsor is entitled to know who stands behind the review. ArkMedis is physician-owned. The Medical Director is accountable for specialty match, conflict screening, and the written determination. Review work is not compensated based on whether a service is approved or denied.
Houston is the primary office. The organization serves plans across the United States. Texas TDI IRO status is applicant only. We do not claim URAC, HITRUST, NCQA, NAIRO, or SOC 2.