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Platform observability
Live counters — 60m window
AIIE scores0
requests / min
Overuse cards0
emitted / min
STAT reclass0
cards / min
Scheduling SLA0
breaches / min
MNAI green0.0%
tier rate %
Autofill0.0%
acceptance %
ARKA is an FDA Non-Device Clinical Decision Support tool under Section 520(o)(1)(E) of the FD&C Act (21st Century Cures Act). This tool provides information to support clinical decisions; it does not replace clinical judgment. INS emphasizes prior authorization, coverage, and cost transparency workflows.
ARKA-INS: Utilization Management
Insurance prior authorization and imaging appropriateness. Run through the RBM workflow with patient selection, order entry, pre-submission analysis, denial risk prediction, documentation assistance, and appeal generation.
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 prediction, 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 for Utilization Management
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.
Key metrics for RBMs
~40%
Average PA review time reduction
~25%
Appeal rate reduction (transparent rationale)
~35%
Auto-approval rate for clearly appropriate studies
How ARKA-INS Works for RBMs
Streamlining utilization management with transparent, evidence-based decisioning.
- 1
Receive Prior Authorization Request
- Imaging order details automatically parsed from incoming PA requests
- Patient demographics, clinical indication, and proposed study extracted
- 2
AIIE Automated Pre-Screen
- AIIE instantly evaluates appropriateness using the same clinical criteria as ARKA-CLIN
- Clear-cut appropriate cases (score 7-9) can be auto-approved
- Clear-cut inappropriate cases (score 1-3) flagged for review with specific reasons
- 3
Evidence-Based Review Support
- For borderline cases (score 4-6), reviewers see exactly which factors influenced the score
- Literature citations provided for each clinical factor
- Reduces reviewer research time and ensures consistency
- 4
Transparent Decision Documentation
- Every approval/denial includes itemized clinical rationale
- Audit trail for compliance and appeals
- Reduces appeal overturn rates by documenting evidence upfront
Benefits for RBMs
Reduce Review Time
Automated pre-screening handles routine cases
Improve Consistency
Same evidence-based criteria across all reviewers
Lower Appeal Rates
Transparent reasoning reduces provider disputes
Compliance Ready
Full audit trail and documentation
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