Utilization Management Demo Steps
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ARKA Clinical Decision Support is designed to meet all four criteria for Non-Device CDS under FD&C Act §520(o)(1)(E) and FDA's January 2026 final guidance on Clinical Decision Support Software. Recommendations support, not replace, the clinician's judgment. Every recommendation is anchored in a published guideline or peer-reviewed source, with the basis available for independent review. INS emphasizes prior authorization, coverage, and cost transparency workflows.
This recommendation is intended to support, not replace, clinical judgment. It is generated by ARKA, software designed to meet the four criteria for Non-Device Clinical Decision Support under FD&C Act §520(o)(1)(E) and FDA's final guidance on Clinical Decision Support Software (January 2026). The clinician is responsible for the final decision.
ARKA-INS
The payer-side demo: run the same appropriateness math clinicians see, streamline prior auth and appeals, and reduce denials — Non-Device CDS, CMS-0057-F ready.
The same engine on the payer side — CMS-0057-F Da Vinci PAS, shipping today.
Which door is yours?
Live counters — 60m window
requests / min
emitted / min
cards / min
breaches / min
tier rate %
acceptance %
RBM workflow benefits. ARKA-INS guides prior authorization through evidence-based RBM (Radiology Benefit Management) criteria. You get pre-submission analysis, documentation gap identification, and criteria mapping so submissions are complete before they reach the payer.
Prior authorization assistance. The demo includes denial risk scoring, AI-generated clinical justification, and appeal letter generation. For high-risk cases you see mitigation steps; for denied cases you can generate a structured appeal with cited guidelines.
Connection to clinical and educational insights. ARKA-INS aligns with ARKA-CLIN (imaging appropriateness) and ARKA-ED (education). Appropriate ordering and strong documentation improve approval rates; learning from denial patterns and criteria strengthens future submissions.
AIIE (ARKA Imaging Intelligence Engine) applies the same clinical appropriateness methodology used by ordering physicians. This creates alignment between clinical and payer perspectives—evidence-based, transparent, and auditable.
Streamlining utilization management with transparent, evidence-based decisioning.
Automated pre-screening handles routine cases
Same evidence-based criteria across all reviewers
Transparent reasoning reduces provider disputes
Full audit trail and documentation
All patients, orders, and outcomes on this page are synthetic (ARKA-DEMO-001); no real patient data.
DEMO MODE
Demonstration only — not for clinical use.
Select a patient scenario to run through the utilization management workflow.
60 years old • Male
Primary Diagnosis
Lumbar Disc Herniation L4-L5
M51.16
36 years old • Female
Primary Diagnosis
Tension-type Headache
G44.209
68 years old • Male
Primary Diagnosis
Lung Nodule - Suspicious
R91.1