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ROI narrative

Imaging denials are a preventable write-off.

Here's the money — conservatively. Modeled for a regional hospital group at 120,000 advanced-imaging orders a year, gross recovery lands near $4.12M/yr^[1]^[3]^[6]. Your inputs will differ — run your own numbers.

ARKA helps hospital systems turn avoidable advanced-imaging denials into clean, paid claims — cutting denial write-offs on their highest-margin service line by up to 30–40% by documenting medical necessity at the point of order and running the same appropriateness check on the payer side — recovering ~$3.5M/yr for a mid-sized system, without adding headcount.

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.

Five levers — where the dollars come from

Each lever below is a conservative, sourced estimate. ARKA is Non-Device CDS — the ordering clinician retains full responsibility for the final decision.

Denial recovery

Clean documentation at the point of order converts would-be denials to clean pays. 86% of imaging denials are potentially avoidable^[1].

Rework labor avoided

Administrative cost to rework a denied claim runs $25–$118 fully loaded; MGMA estimates 50–65% of denials are never reworked^[3].

Throughput defense

Faster prior-auth approvals shorten the backlog on your highest-margin imaging line — modeled at $500K/yr at baseline volume^[6].

Admin redirected

When documentation is complete at order entry, clean orders clear payer review without a queue — 35–40% of orders auto-clear^[4].

Compliance risk avoided

CMS-0057-F requires a specific denial reason enforced through 2026 and four FHIR APIs (including Da Vinci PAS) by January 1, 2027. CMS-0057-F compliance matrix.

Worked example — mid-sized system

20,000 advanced-imaging orders per year · 20% initial denial rate · blended reimbursement $1K^[6].

Modeled — your inputs will differ. Figures use the same conservative assumptions as the interactive ROI calculator; every assumption, its source, and its provenance are documented in the ROI methodology.

Modeled ROI for a mid-sized health system with 20,000 advanced-imaging orders and a 20% denial rate
Value at risk $2.17M^[1]^[3]^[2] Modeled	Modeled gross recovery / yr $686K^[1]^[3]^[6] Modeled	Payback <6 months^[1] Modeled	Year-1 net $388K^[1]^[3] Modeled

At-risk revenue reflects permanently lost avoidable denials (never reworked). Gross recovery includes denial conversion, rework labor avoided, and throughput defense — subscription cost deducted for Year-1 net. Assumes 2.5% of all studies converted to clean pays and a ~2.3× first-year return multiple.

How we measure it with you

Modeled economics get you to a business case. Measured outcomes get you to a contract. We align on KPIs before go-live — denial-rate trend, PA turnaround within CMS-0057-F SLAs, appropriateness score distribution, and rework hours avoided — using the framework in our Outcomes & KPI guide.

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
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.
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.
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.
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.
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).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.

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ROI narrative

Imaging denials are a preventable write-off.

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.

Five levers — where the dollars come from

Each lever below is a conservative, sourced estimate. ARKA is Non-Device CDS — the ordering clinician retains full responsibility for the final decision.

Denial recovery

Clean documentation at the point of order converts would-be denials to clean pays. 86% of imaging denials are potentially avoidable^[1].

Rework labor avoided

Administrative cost to rework a denied claim runs $25–$118 fully loaded; MGMA estimates 50–65% of denials are never reworked^[3].

Throughput defense

Faster prior-auth approvals shorten the backlog on your highest-margin imaging line — modeled at $500K/yr at baseline volume^[6].

Admin redirected

When documentation is complete at order entry, clean orders clear payer review without a queue — 35–40% of orders auto-clear^[4].

Compliance risk avoided

CMS-0057-F requires a specific denial reason enforced through 2026 and four FHIR APIs (including Da Vinci PAS) by January 1, 2027. CMS-0057-F compliance matrix.

Worked example — mid-sized system

20,000 advanced-imaging orders per year · 20% initial denial rate · blended reimbursement $1K^[6].

Modeled ROI for a mid-sized health system with 20,000 advanced-imaging orders and a 20% denial rate
Value at risk $2.17M^[1]^[3]^[2] Modeled	Modeled gross recovery / yr $686K^[1]^[3]^[6] Modeled	Payback <6 months^[1] Modeled	Year-1 net $388K^[1]^[3] Modeled

How we measure it with you

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
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.
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.
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.
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.
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).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.

Loading…

ROI narrative

Imaging denials are a preventable write-off.

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.

Five levers — where the dollars come from

Each lever below is a conservative, sourced estimate. ARKA is Non-Device CDS — the ordering clinician retains full responsibility for the final decision.

Denial recovery

Clean documentation at the point of order converts would-be denials to clean pays. 86% of imaging denials are potentially avoidable^[1].

Rework labor avoided

Administrative cost to rework a denied claim runs $25–$118 fully loaded; MGMA estimates 50–65% of denials are never reworked^[3].

Throughput defense

Faster prior-auth approvals shorten the backlog on your highest-margin imaging line — modeled at $500K/yr at baseline volume^[6].

Admin redirected

When documentation is complete at order entry, clean orders clear payer review without a queue — 35–40% of orders auto-clear^[4].

Compliance risk avoided

CMS-0057-F requires a specific denial reason enforced through 2026 and four FHIR APIs (including Da Vinci PAS) by January 1, 2027. CMS-0057-F compliance matrix.

Worked example — mid-sized system

20,000 advanced-imaging orders per year · 20% initial denial rate · blended reimbursement $1K^[6].

Modeled ROI for a mid-sized health system with 20,000 advanced-imaging orders and a 20% denial rate
Value at risk $2.17M^[1]^[3]^[2] Modeled	Modeled gross recovery / yr $686K^[1]^[3]^[6] Modeled	Payback <6 months^[1] Modeled	Year-1 net $388K^[1]^[3] Modeled

How we measure it with you

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
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.
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.
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.
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.
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).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.

ROI narrative

Imaging denials are a preventable write-off.

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.

Five levers — where the dollars come from

Each lever below is a conservative, sourced estimate. ARKA is Non-Device CDS — the ordering clinician retains full responsibility for the final decision.

Denial recovery

Clean documentation at the point of order converts would-be denials to clean pays. 86% of imaging denials are potentially avoidable^[1].

Rework labor avoided

Administrative cost to rework a denied claim runs $25–$118 fully loaded; MGMA estimates 50–65% of denials are never reworked^[3].

Throughput defense

Faster prior-auth approvals shorten the backlog on your highest-margin imaging line — modeled at $500K/yr at baseline volume^[6].

Admin redirected

When documentation is complete at order entry, clean orders clear payer review without a queue — 35–40% of orders auto-clear^[4].

Compliance risk avoided

CMS-0057-F requires a specific denial reason enforced through 2026 and four FHIR APIs (including Da Vinci PAS) by January 1, 2027. CMS-0057-F compliance matrix.

Worked example — mid-sized system

20,000 advanced-imaging orders per year · 20% initial denial rate · blended reimbursement $1K^[6].

Modeled ROI for a mid-sized health system with 20,000 advanced-imaging orders and a 20% denial rate
Value at risk $2.17M^[1]^[3]^[2] Modeled	Modeled gross recovery / yr $686K^[1]^[3]^[6] Modeled	Payback <6 months^[1] Modeled	Year-1 net $388K^[1]^[3] Modeled

How we measure it with you

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
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.
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.
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.
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.
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).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.