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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. CLIN emphasizes imaging appropriateness at order entry.
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 ROI MODEL · CONSERVATIVE CASE
Enter your imaging volume and payer mix — get a modeled, conservative recovery number in seconds, built on the same published sources as the breakdown below.
← Back to homeBasics
35%
12%
86%
55%
60%
35%
25%
50%
Pricing
Modeled · conservative
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.
Modeled at ARKA Pro $0.45 PMPM × 300,000 lives
$4.65M / yr
Net of ARKA cost: $3.03M
Denial prevention
$4.08M
Documents medical necessity at the point of order, so avoidable denials never happen.
Rework labor avoided
$86K
Fewer denials means fewer appeals your staff has to work.
Prior-auth admin saved
$286K
Automates the ~24-min manual PA your team does today.
Throughput recovered
$198K
Faster approvals keep would-be-abandoned studies on the schedule — on your highest-margin line.
Effective denial rate
min(45%, 12% base + 35% MA × 4 pts = 12% + 1.4%)
= 13.4%
Avoidable denied orders
120,000 orders × 13.4% effective denial × 86% avoidable
= 13,829 orders
Revenue at risk today
13,829 avoidable denials × 55% never reworked × $1,180
= $8.97M
Prevented denials
13,829 avoidable denials × 25% reduction
= 3,457 orders
Denial recovery (Lever 1)
3,457 prevented × $1,180
= $4.08M
Rework avoided (Lever 2)
3,457 prevented × $25 rework cost
= $86K
Automated prior authorizations
120,000 orders × 60% require PA × 50% automated
= 36,000 PAs
Admin labor saved (Lever 3)
36,000 PAs × (14 min ÷ 60) × $34/hr
= $286K
Contribution per study
$1,180 reimbursement × 35% margin
= $413
Throughput studies recovered
120,000 orders × 0.4% recovery rate
= 480 studies
Throughput upside (Lever 4)
480 studies × $413 contribution
= $198K
Gross annual benefit
$4.08M + $86K + $286K + $198K
= $4.65M
ARKA annual cost
$0 PMPM × 300,000 lives × 12 mo
= $1.62M
Net annual benefit
$4.65M gross − $1.62M ARKA cost
= $3.03M
First-year ROI multiple
$4.65M ÷ $1.62M
= 2.9×
Payback period
$1.62M ÷ ($4.65M ÷ 12 mo)
= 4.2 months
Sources
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.
A defensible dollar figure built from explicit, cited assumptions. Every input below carries its source and a provenance chip — expand any assumption to see the math behind it. Headline figures are Modeled, never measured.
Payer view · primary
$15.1M/ yr
Reduced low-value advanced imaging, prior-auth admin avoided via auto-approval / gold-carding, and lower peer-to-peer / appeal volume.
Reduced low-value advanced imaging
12,000 low-value studies redirected × avg allowed amount.
Prior-auth admin cost avoided (auto-approval / gold-carding)
45,600 PAs auto-approved × ~$11.33/PA (13 h ÷ 39 PAs × loaded rate).
Reduced peer-to-peer / appeal volume
3,648 appeals + 2,280 peer-to-peers avoided.
Planning volume for a regional health plan / large integrated network; operator-adjustable input, not an ARKA measurement.
Conservative low end of published low-value / inappropriate advanced-imaging shares (RAND/UCLA appropriateness method; ACR Appropriateness Criteria).
Modeled share of low-value orders ARKA redirects to a more appropriate pathway or resolves at order entry.
Blended commercial-vs-Medicare allowed amount per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗
Advanced imaging (MRI/CT/PET) requires prior authorization under most commercial and Medicare Advantage plans.
AMA 2024 Prior Authorization Physician Survey — practices complete ~39 prior authorizations per physician per week. AMA 2024 Prior Authorization Physician Survey ↗
AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗
Loaded medical-administrative labor cost per hour (wages + benefits + overhead).
Modeled share of advanced-imaging prior authorizations eligible for auto-approval / gold-carding under ARKA appropriateness thresholds.
Modeled share of prior authorizations that generate a written appeal.
Modeled share of prior authorizations escalating to a physician peer-to-peer review.
Modeled administrative cost to adjudicate one appeal (within the published $25–$118 claim-handling range). MGMA / Change Healthcare — cost to rework a denied claim ↗
Modeled cost of one physician peer-to-peer review (~1 physician-hour at a loaded rate).
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.
Provider view
$1.87M/ yr
Denial-recovery dollars plus documentation-time returned to clinicians.
Denial-recovery dollars
1,466 avoidable denials prevented → recovered revenue + rework labor avoided.
Documentation-time savings
7,488 clinician hours returned × loaded clinician rate.
Annual advanced-imaging order volume for a mid-size health system (illustrative planning input).
Conservative midpoint of the published 20–40% prior-authorization denial band for advanced imaging. KFF — ACA Marketplace claims denials & appeals (2023) ↗
Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable. Change Healthcare 2020 Denials Index ↗
MGMA — 50–65% of denied claims are never reworked (55% midpoint). MGMA / Change Healthcare — cost to rework a denied claim ↗
Modeled relative reduction in avoidable denials when documentation gaps are closed at order entry.
Blended reimbursement per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗
MGMA / Change Healthcare — ~$25 administrative cost to rework a denied claim. MGMA / Change Healthcare — cost to rework a denied claim ↗
Illustrative count of ordering physicians in the group.
AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗
Modeled reduction in documentation / prior-auth time when ARKA supplies structured indications at order entry.
Assumed clinical working weeks per year (52 minus leave and holidays).
Loaded clinician cost per hour (compensation + overhead).
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.
Modeled for a regional hospital group running ~120,000 advanced imaging studies a year. Every figure is a conservative estimate built on published CAQH, KFF, MGMA, AMA, ACR, Change Healthcare, and Johns Hopkins data — sourced at the bottom of this page.
~$3.5M
Modeledrecovered / yr in avoidable imaging denials
ARKA ROI model — modeled gross recovery for a regional group at 120,000 advanced-imaging orders/yr; built on the published sources below.
86%
Measuredof imaging denials are avoidable
Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable.
<800ms
Measuredto score an order, in-flow, no extra click
Measured median CDS Hooks scoring latency in the Stormont Vail retrospective evaluation (simulated Epic chart).
35–40%
Modeledof orders auto-clear and never hit a queue
Modeled share of clearly-appropriate orders that bypass the manual PA queue under pilot thresholds.
Every lever below is a modeled projection under the assumptions in the next section — see the full ROI methodology for how each is computed.
Modeled gross recovery: $4.12M / yr
Each input is tagged Measured (from a cited study), Modeled (an ARKA projection), or Illustrative (an operator-adjustable planning input). Full derivations live in the ROI methodology.
Clean documentation at point of order converts would-be denials to clean pays.
Fewer denials means fewer appeals worked by staff.
Faster approvals shorten the backlog on your highest-margin line.
When the clinician's documentation is complete, clean orders clear payer review without a queue.
Priced at ~$0.30–$0.50 PMPM — a modeled ~2.3× first-year return.
ModeledModeled ARKA annual cost ($1.79M) vs. modeled gross recovery ($4.12M) at ~2.3× return.
86% of denials are potentially avoidable (34% unequivocally avoidable).1
Change Healthcare 2020 ↗1. Change Healthcare 2020 Denials Index
86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
https://www.rivethealth.com/blog/denials-revenue-cycle-management2. KFF — ACA Marketplace claims denials & appeals (2023)
HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/3. MGMA / Change Healthcare — cost to rework a denied claim
~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
https://www.mgma.com/mgma-stats/6-keys-to-addressing-denials-in-your-medical-practice-s-revenue-cycle4. CAQH Index (2023 / 2024)
Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
https://www.caqh.org/hubfs/43908627/drupal/2024-01/2023_CAQH_Index_Report.pdf5. AMA 2024 Prior Authorization Physician Survey
Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
https://www.ama-assn.org/practice-management/prior-authorization/exhausted-prior-auth-many-patients-abandon-care-ama-survey6. Johns Hopkins — commercial vs. Medicare radiology prices (2021)
Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
https://hub.jhu.edu/2021/12/13/radiological-services-compared-to-medicare/7. HHS OIG — Medicare Advantage prior-authorization denials
Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdfModeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.
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. CLIN emphasizes imaging appropriateness at order entry.
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 ROI MODEL · CONSERVATIVE CASE
Enter your imaging volume and payer mix — get a modeled, conservative recovery number in seconds, built on the same published sources as the breakdown below.
← Back to homeBasics
35%
12%
86%
55%
60%
35%
25%
50%
Pricing
Modeled · conservative
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.
Modeled at ARKA Pro $0.45 PMPM × 300,000 lives
$4.65M / yr
Net of ARKA cost: $3.03M
Denial prevention
$4.08M
Documents medical necessity at the point of order, so avoidable denials never happen.
Rework labor avoided
$86K
Fewer denials means fewer appeals your staff has to work.
Prior-auth admin saved
$286K
Automates the ~24-min manual PA your team does today.
Throughput recovered
$198K
Faster approvals keep would-be-abandoned studies on the schedule — on your highest-margin line.
Effective denial rate
min(45%, 12% base + 35% MA × 4 pts = 12% + 1.4%)
= 13.4%
Avoidable denied orders
120,000 orders × 13.4% effective denial × 86% avoidable
= 13,829 orders
Revenue at risk today
13,829 avoidable denials × 55% never reworked × $1,180
= $8.97M
Prevented denials
13,829 avoidable denials × 25% reduction
= 3,457 orders
Denial recovery (Lever 1)
3,457 prevented × $1,180
= $4.08M
Rework avoided (Lever 2)
3,457 prevented × $25 rework cost
= $86K
Automated prior authorizations
120,000 orders × 60% require PA × 50% automated
= 36,000 PAs
Admin labor saved (Lever 3)
36,000 PAs × (14 min ÷ 60) × $34/hr
= $286K
Contribution per study
$1,180 reimbursement × 35% margin
= $413
Throughput studies recovered
120,000 orders × 0.4% recovery rate
= 480 studies
Throughput upside (Lever 4)
480 studies × $413 contribution
= $198K
Gross annual benefit
$4.08M + $86K + $286K + $198K
= $4.65M
ARKA annual cost
$0 PMPM × 300,000 lives × 12 mo
= $1.62M
Net annual benefit
$4.65M gross − $1.62M ARKA cost
= $3.03M
First-year ROI multiple
$4.65M ÷ $1.62M
= 2.9×
Payback period
$1.62M ÷ ($4.65M ÷ 12 mo)
= 4.2 months
Sources
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.
A defensible dollar figure built from explicit, cited assumptions. Every input below carries its source and a provenance chip — expand any assumption to see the math behind it. Headline figures are Modeled, never measured.
Payer view · primary
$15.1M/ yr
Reduced low-value advanced imaging, prior-auth admin avoided via auto-approval / gold-carding, and lower peer-to-peer / appeal volume.
Reduced low-value advanced imaging
12,000 low-value studies redirected × avg allowed amount.
Prior-auth admin cost avoided (auto-approval / gold-carding)
45,600 PAs auto-approved × ~$11.33/PA (13 h ÷ 39 PAs × loaded rate).
Reduced peer-to-peer / appeal volume
3,648 appeals + 2,280 peer-to-peers avoided.
Planning volume for a regional health plan / large integrated network; operator-adjustable input, not an ARKA measurement.
Conservative low end of published low-value / inappropriate advanced-imaging shares (RAND/UCLA appropriateness method; ACR Appropriateness Criteria).
Modeled share of low-value orders ARKA redirects to a more appropriate pathway or resolves at order entry.
Blended commercial-vs-Medicare allowed amount per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗
Advanced imaging (MRI/CT/PET) requires prior authorization under most commercial and Medicare Advantage plans.
AMA 2024 Prior Authorization Physician Survey — practices complete ~39 prior authorizations per physician per week. AMA 2024 Prior Authorization Physician Survey ↗
AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗
Loaded medical-administrative labor cost per hour (wages + benefits + overhead).
Modeled share of advanced-imaging prior authorizations eligible for auto-approval / gold-carding under ARKA appropriateness thresholds.
Modeled share of prior authorizations that generate a written appeal.
Modeled share of prior authorizations escalating to a physician peer-to-peer review.
Modeled administrative cost to adjudicate one appeal (within the published $25–$118 claim-handling range). MGMA / Change Healthcare — cost to rework a denied claim ↗
Modeled cost of one physician peer-to-peer review (~1 physician-hour at a loaded rate).
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.
Provider view
$1.87M/ yr
Denial-recovery dollars plus documentation-time returned to clinicians.
Denial-recovery dollars
1,466 avoidable denials prevented → recovered revenue + rework labor avoided.
Documentation-time savings
7,488 clinician hours returned × loaded clinician rate.
Annual advanced-imaging order volume for a mid-size health system (illustrative planning input).
Conservative midpoint of the published 20–40% prior-authorization denial band for advanced imaging. KFF — ACA Marketplace claims denials & appeals (2023) ↗
Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable. Change Healthcare 2020 Denials Index ↗
MGMA — 50–65% of denied claims are never reworked (55% midpoint). MGMA / Change Healthcare — cost to rework a denied claim ↗
Modeled relative reduction in avoidable denials when documentation gaps are closed at order entry.
Blended reimbursement per advanced-imaging study. Johns Hopkins — commercial vs. Medicare radiology prices (2021) ↗
MGMA / Change Healthcare — ~$25 administrative cost to rework a denied claim. MGMA / Change Healthcare — cost to rework a denied claim ↗
Illustrative count of ordering physicians in the group.
AMA 2024 Prior Authorization Physician Survey — physicians and staff spend ~13 hours per week on prior authorization. AMA 2024 Prior Authorization Physician Survey ↗
Modeled reduction in documentation / prior-auth time when ARKA supplies structured indications at order entry.
Assumed clinical working weeks per year (52 minus leave and holidays).
Loaded clinician cost per hour (compensation + overhead).
Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes.
Modeled for a regional hospital group running ~120,000 advanced imaging studies a year. Every figure is a conservative estimate built on published CAQH, KFF, MGMA, AMA, ACR, Change Healthcare, and Johns Hopkins data — sourced at the bottom of this page.
~$3.5M
Modeledrecovered / yr in avoidable imaging denials
ARKA ROI model — modeled gross recovery for a regional group at 120,000 advanced-imaging orders/yr; built on the published sources below.
86%
Measuredof imaging denials are avoidable
Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable.
<800ms
Measuredto score an order, in-flow, no extra click
Measured median CDS Hooks scoring latency in the Stormont Vail retrospective evaluation (simulated Epic chart).
35–40%
Modeledof orders auto-clear and never hit a queue
Modeled share of clearly-appropriate orders that bypass the manual PA queue under pilot thresholds.
Every lever below is a modeled projection under the assumptions in the next section — see the full ROI methodology for how each is computed.
Modeled gross recovery: $4.12M / yr
Each input is tagged Measured (from a cited study), Modeled (an ARKA projection), or Illustrative (an operator-adjustable planning input). Full derivations live in the ROI methodology.
Clean documentation at point of order converts would-be denials to clean pays.
Fewer denials means fewer appeals worked by staff.
Faster approvals shorten the backlog on your highest-margin line.
When the clinician's documentation is complete, clean orders clear payer review without a queue.
Priced at ~$0.30–$0.50 PMPM — a modeled ~2.3× first-year return.
ModeledModeled ARKA annual cost ($1.79M) vs. modeled gross recovery ($4.12M) at ~2.3× return.
86% of denials are potentially avoidable (34% unequivocally avoidable).1
Change Healthcare 2020 ↗1. Change Healthcare 2020 Denials Index
86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
https://www.rivethealth.com/blog/denials-revenue-cycle-management2. KFF — ACA Marketplace claims denials & appeals (2023)
HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/3. MGMA / Change Healthcare — cost to rework a denied claim
~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
https://www.mgma.com/mgma-stats/6-keys-to-addressing-denials-in-your-medical-practice-s-revenue-cycle4. CAQH Index (2023 / 2024)
Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
https://www.caqh.org/hubfs/43908627/drupal/2024-01/2023_CAQH_Index_Report.pdf5. AMA 2024 Prior Authorization Physician Survey
Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
https://www.ama-assn.org/practice-management/prior-authorization/exhausted-prior-auth-many-patients-abandon-care-ama-survey6. Johns Hopkins — commercial vs. Medicare radiology prices (2021)
Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
https://hub.jhu.edu/2021/12/13/radiological-services-compared-to-medicare/7. HHS OIG — Medicare Advantage prior-authorization denials
Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdfModeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.