Health plans
Medical necessity review, appeal-ready rationale, specialty match, and Medical Director oversight — plus a clear list of what we do not offer.
Independent Review Organization
Nationwide independent medical review.
Physician-led and patient-first: ArkMedis delivers impartial medical necessity review under Medical Director oversight for health plans and TPAs across the U.S. Primary office in Houston. Portal sign-in requires MFA (verified email and a second factor). Authorized users can upload case files in the portal. Review begins after TDI Independent Review Organization certification is issued. Certification is not active.
Who we serve
Serving health plans and TPAs across the U.S.
Clear roles, documented independence, and channels that keep PHI off public email and fax.
TPAs
A clinically independent partner for self-funded and fully insured book-of-business review workflows nationwide.
Self-funded employers
Impartial determinations that help plan sponsors meet fiduciary expectations with clear documentation.
Providers & reviewers
Clinicians can ask about the reviewer network. Case files from authorized users go through the portal vault, not email.
Solutions
Clinical review that stays independent.
Focused independent medical review for national plan and TPA partners — built to do the core work well from day one.
Independent medical necessity review
Impartial review of utilization decisions against the clinical record and applicable standards of care.
Specialty-matched reviewers
Cases routed to clinicians whose specialty aligns with the clinical question — not a one-size panel. We are building a specialty-matched reviewer network nationwide to deepen coverage over time (no inflated headcount claims).
Appeals
Written rationale for a contested utilization decision. Not attorney representation and not a 50-state external-review claim.
Secure case 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.
Across the site
Services, boundaries, and company pages.
Each route is a real page. Consulting, workers’ compensation, legal services, and software say they are not offered.
Utilization review
Outside review of a utilization question. Not the plan’s UM department.
Medical Director
Oversight of ArkMedis determinations. Not on-demand staffing.
Insights
Explainers we maintain. No blog and no invented articles.
Careers
No posted openings. Clinicians can send a non-PHI note.
Consulting
Accreditation and operational consulting are not offered.
Workers’ compensation
Comp review is not offered. Do not send claim files.
Legal services
Not a law firm and not attorney representation.
Software
No UM product for sale. The portal is a case workspace.
About
Independence is the product.
Physician-owned & accountable
ArkMedis is a physician-owned Independent Review Organization. Clinical accountability sits with our MD Medical Director: specialty match, conflict-of-interest screening, and written rationale on every determination. Integrity and independence come first — free from volume targets, relationship pressure, or outcome incentives. We operate as an independent clinical review organization; we do not claim nonprofit status.
- Physician ownership with MD Medical Director oversight
- Documented conflict-of-interest screening
- Specialty alignment on clinical questions (building network — no inflated headcount)
- Written rationale with each determination
Records & operations
Primary office in Houston. Electronic records and case workflow designed for regulated independent review, including the Texas Department of Insurance (TDI) IRO pathway we are on as a Texas IRO applicant, with public operations visible on this site.
Workspace HIPAA BAA and Google Cloud HIPAA BAA are both held. 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. We do not claim certified IRO status.
We do not claim URAC, HITRUST, NCQA, NAIRO, SOC 2, or “certified IRO” status. See Security & Trust and the checklist on About.
What is an Independent Review Organization (IRO)?
An IRO provides impartial clinical review of utilization and medical necessity decisions — separate from the health plan’s own medical staff — so determinations rest on the clinical record and applicable standards of care. Read more
Who does ArkMedis serve?
Health plans, TPAs, and self-funded employers across the U.S. We are open to conversations with government and program partners. We do not currently market PBM or LTD review as active offerings. Read more
How is PHI handled today?
Do not send PHI by email or fax. Workspace and Google Cloud HIPAA BAAs are held. Authorized portal users can upload a case file after MFA (verified email and a second factor). ArkMedis will review submitted cases after Texas Department of Insurance Independent Review Organization certification is issued. The application is in process. Certification is not active. Read more
What does “Texas TDI IRO applicant” mean?
ArkMedis is on the Texas Department of Insurance Independent Review Organization certification pathway. We do not claim “certified IRO” status until certification is actually held. Read more
How do you match specialties?
We route cases to clinicians whose specialty aligns with the clinical question. Coverage is building nationwide under Medical Director oversight — we do not invent panel size or a finished specialty list. Read more
How do you protect independence?
Physician ownership, MD Medical Director accountability, documented conflict-of-interest screening, and written rationale on every determination — free from volume targets or outcome incentives. Read more
How do we start an engagement?
Start with Contact for non-PHI partnership and operational setup. Authorized users upload case PHI only through the portal after MFA. ArkMedis will review those files after TDI Independent Review Organization certification is issued. Certification is not active. Read more
Ready to talk partnership?
Contact is the path for non-PHI introductions and operational setup. 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.