ARKA-INS / Validation

ROI & validation command center

Aggregate metrics from ins_validation_events and ins_pa_history. Click any KPI to audit underlying rows.

Payer view · primary

Estimated annual savings

Modeled

$15.1M/ yr

Reduced low-value advanced imaging, prior-auth admin avoided via auto-approval / gold-carding, and lower peer-to-peer / appeal volume.

$14.2MModeled
Reduced low-value advanced imaging
12,000 low-value studies redirected × avg allowed amount.
$517KModeled
Prior-auth admin cost avoided (auto-approval / gold-carding)
45,600 PAs auto-approved × ~$11.33/PA (13 h ÷ 39 PAs × loaded rate).
$456KModeled
Reduced peer-to-peer / appeal volume
3,648 appeals + 2,280 peer-to-peers avoided.

Assumptions (13)▾

Advanced imaging orders / yrIllustrative

Planning volume for a regional health plan / large integrated network; operator-adjustable input, not an ARKA measurement.

120,000

Low-value share of advanced imagingModeled

Conservative low end of published low-value / inappropriate advanced-imaging shares (RAND/UCLA appropriateness method; ACR Appropriateness Criteria).

20%

Low-value orders ARKA redirectsModeled

Modeled share of low-value orders ARKA redirects to a more appropriate pathway or resolves at order entry.

50%

Avg allowed amount per studyModeled

Blended commercial-vs-Medicare allowed amount per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗

$1,180

Orders requiring prior authModeled

Advanced imaging (MRI/CT/PET) requires prior authorization under most commercial and Medicare Advantage plans.

95%

Prior auths per physician / weekMeasured

AMA 2024 Prior Authorization Physician Survey — practices complete ~39 prior authorizations per physician per week. AMA 2024 Prior Authorization Physician Survey ↗

Hours per physician / week on PAMeasured

AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗

13 h

Loaded PA staff cost / hourModeled

Loaded medical-administrative labor cost per hour (wages + benefits + overhead).

$34

PAs auto-approved / gold-cardedModeled

Modeled share of advanced-imaging prior authorizations eligible for auto-approval / gold-carding under ARKA appropriateness thresholds.

40%

PAs that generate an appealModeled

Modeled share of prior authorizations that generate a written appeal.

PAs escalating to peer-to-peerModeled

Modeled share of prior authorizations escalating to a physician peer-to-peer review.

Cost per appealModeled

Modeled administrative cost to adjudicate one appeal (within the published $25–$118 claim-handling range). MGMA / Change Healthcare — cost to rework a denied claim ↗

$50

Cost per peer-to-peerModeled

Modeled cost of one physician peer-to-peer review (~1 physician-hour at a loaded rate).

$120

Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.

Provider view

Estimated annual savings

Modeled

$1.87M/ yr

Denial-recovery dollars plus documentation-time returned to clinicians.

$968KModeled
Denial-recovery dollars
1,466 avoidable denials prevented → recovered revenue + rework labor avoided.
$899KModeled
Documentation-time savings
7,488 clinician hours returned × loaded clinician rate.

Assumptions (12)▾

Advanced imaging orders / yrIllustrative

Annual advanced-imaging order volume for a mid-size health system (illustrative planning input).

31,000

Prior-auth denial rateModeled

Conservative midpoint of the published 20–40% prior-authorization denial band for advanced imaging. KFF — ACA Marketplace claims denials & appeals (2023) ↗

22%

Share of denials that are avoidableMeasured

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable. Change Healthcare 2020 Denials Index ↗

86%

Denials never reworkedMeasured

MGMA — 50–65% of denied claims are never reworked (55% midpoint). MGMA / Change Healthcare — cost to rework a denied claim ↗

55%

Avoidable denials ARKA preventsModeled

Modeled relative reduction in avoidable denials when documentation gaps are closed at order entry.

25%

Avg reimbursement per studyModeled

Blended reimbursement per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗

$1,180

Cost to rework a denied claimMeasured

MGMA / Change Healthcare — ~$25 administrative cost to rework a denied claim. MGMA / Change Healthcare — cost to rework a denied claim ↗

$25

Ordering physiciansIllustrative

Illustrative count of ordering physicians in the group.

Hours per physician / week on PAMeasured

AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗

13 h

Documentation / PA time ARKA savesModeled

Modeled reduction in documentation / prior-auth time when ARKA supplies structured indications at order entry.

20%

Clinical working weeks / yrIllustrative

Assumed clinical working weeks per year (52 minus leave and holidays).

48 wk

Loaded clinician cost / hourModeled

Loaded clinician cost per hour (compensation + overhead).

$120

Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.

Date rangePayerSpecialtyCPT modality

Administrative burden

Weekly minutes saved · last 12 weeks · AMA 13 h/wk reference

Reduction vs national PA baseline: 0.0%

Cost avoidance (USD)

Stacked: appeals + inappropriate imaging + admin labor

Click stack segments to trace events. Labor uses $0.85/min fully loaded proxy (see Methodology).

Denial specificity

Specific reason codes vs boilerplate (model)

AIIE-aligned specificity score: 100%

Payer ROI

Payer	PAs	Auto-appr.	Avg decision (h)	Appeal overturn	Est. annual $

No payer rows in this range.

Annual savings annualized from period appeal, imaging, OOP, and labor components. Date range follows global filter above.

OOP transparency impact

Patient-facing savings and site routing — a differentiator versus traditional RBM: dollars returned to members, not only administrative efficiency.

Cheaper-site reroutes

Total patient OOP savings

Histogram uses estimated OOP buckets from oop_estimate_presented and realized savings rows.

ARKA-INS / Validation

ROI & validation command center

Aggregate metrics from ins_validation_events and ins_pa_history. Click any KPI to audit underlying rows.

Payer view · primary

Estimated annual savings

Modeled

$15.1M/ yr

Reduced low-value advanced imaging, prior-auth admin avoided via auto-approval / gold-carding, and lower peer-to-peer / appeal volume.

$14.2MModeled
Reduced low-value advanced imaging
12,000 low-value studies redirected × avg allowed amount.
$517KModeled
Prior-auth admin cost avoided (auto-approval / gold-carding)
45,600 PAs auto-approved × ~$11.33/PA (13 h ÷ 39 PAs × loaded rate).
$456KModeled
Reduced peer-to-peer / appeal volume
3,648 appeals + 2,280 peer-to-peers avoided.

Assumptions (13)▾

Advanced imaging orders / yrIllustrative

Planning volume for a regional health plan / large integrated network; operator-adjustable input, not an ARKA measurement.

120,000

Low-value share of advanced imagingModeled

Conservative low end of published low-value / inappropriate advanced-imaging shares (RAND/UCLA appropriateness method; ACR Appropriateness Criteria).

20%

Low-value orders ARKA redirectsModeled

Modeled share of low-value orders ARKA redirects to a more appropriate pathway or resolves at order entry.

50%

Avg allowed amount per studyModeled

Blended commercial-vs-Medicare allowed amount per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗

$1,180

Orders requiring prior authModeled

Advanced imaging (MRI/CT/PET) requires prior authorization under most commercial and Medicare Advantage plans.

95%

Prior auths per physician / weekMeasured

AMA 2024 Prior Authorization Physician Survey — practices complete ~39 prior authorizations per physician per week. AMA 2024 Prior Authorization Physician Survey ↗

Hours per physician / week on PAMeasured

AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗

13 h

Loaded PA staff cost / hourModeled

Loaded medical-administrative labor cost per hour (wages + benefits + overhead).

$34

PAs auto-approved / gold-cardedModeled

Modeled share of advanced-imaging prior authorizations eligible for auto-approval / gold-carding under ARKA appropriateness thresholds.

40%

PAs that generate an appealModeled

Modeled share of prior authorizations that generate a written appeal.

PAs escalating to peer-to-peerModeled

Modeled share of prior authorizations escalating to a physician peer-to-peer review.

Cost per appealModeled

Modeled administrative cost to adjudicate one appeal (within the published $25–$118 claim-handling range). MGMA / Change Healthcare — cost to rework a denied claim ↗

$50

Cost per peer-to-peerModeled

Modeled cost of one physician peer-to-peer review (~1 physician-hour at a loaded rate).

$120

Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.

Provider view

Estimated annual savings

Modeled

$1.87M/ yr

Denial-recovery dollars plus documentation-time returned to clinicians.

$968KModeled
Denial-recovery dollars
1,466 avoidable denials prevented → recovered revenue + rework labor avoided.
$899KModeled
Documentation-time savings
7,488 clinician hours returned × loaded clinician rate.

Assumptions (12)▾

Advanced imaging orders / yrIllustrative

Annual advanced-imaging order volume for a mid-size health system (illustrative planning input).

31,000

Prior-auth denial rateModeled

Conservative midpoint of the published 20–40% prior-authorization denial band for advanced imaging. KFF — ACA Marketplace claims denials & appeals (2023) ↗

22%

Share of denials that are avoidableMeasured

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable. Change Healthcare 2020 Denials Index ↗

86%

Denials never reworkedMeasured

MGMA — 50–65% of denied claims are never reworked (55% midpoint). MGMA / Change Healthcare — cost to rework a denied claim ↗

55%

Avoidable denials ARKA preventsModeled

Modeled relative reduction in avoidable denials when documentation gaps are closed at order entry.

25%

Avg reimbursement per studyModeled

Blended reimbursement per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗

$1,180

Cost to rework a denied claimMeasured

MGMA / Change Healthcare — ~$25 administrative cost to rework a denied claim. MGMA / Change Healthcare — cost to rework a denied claim ↗

$25

Ordering physiciansIllustrative

Illustrative count of ordering physicians in the group.

Hours per physician / week on PAMeasured

AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗

13 h

Documentation / PA time ARKA savesModeled

Modeled reduction in documentation / prior-auth time when ARKA supplies structured indications at order entry.

20%

Clinical working weeks / yrIllustrative

Assumed clinical working weeks per year (52 minus leave and holidays).

48 wk

Loaded clinician cost / hourModeled

Loaded clinician cost per hour (compensation + overhead).

$120

Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.

Date rangePayerSpecialtyCPT modality

Administrative burden

Weekly minutes saved · last 12 weeks · AMA 13 h/wk reference

Reduction vs national PA baseline: 0.0%

Cost avoidance (USD)

Stacked: appeals + inappropriate imaging + admin labor

Click stack segments to trace events. Labor uses $0.85/min fully loaded proxy (see Methodology).

Denial specificity

Specific reason codes vs boilerplate (model)

AIIE-aligned specificity score: 100%

Payer ROI

Payer	PAs	Auto-appr.	Avg decision (h)	Appeal overturn	Est. annual $

No payer rows in this range.

Annual savings annualized from period appeal, imaging, OOP, and labor components. Date range follows global filter above.

OOP transparency impact

Patient-facing savings and site routing — a differentiator versus traditional RBM: dollars returned to members, not only administrative efficiency.

Cheaper-site reroutes

Total patient OOP savings

Histogram uses estimated OOP buckets from oop_estimate_presented and realized savings rows.