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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. CLIN emphasizes imaging appropriateness at order entry.
Rural reimbursement tools — exemptions, batch authorization, revenue intelligence, and grant navigation.
Batch queue
2
Demo orders
Denial rate (demo)
8%
Rolling
Rural adj.
+3%
Illustrative
Medicare
Auto-detectablecritical access exemption
Critical Access Hospitals are exempt from certain outpatient imaging prior authorization requirements under Medicare
Blue Cross Blue Shield of Kansas
Auto-detectabletravel distance exception
When patient must travel >50 miles for an imaging study, BCBS-KS allows an alternative study at the local facility without standard prior authorization
Aetna
Auto-detectablegold card rural
Rural facilities with imaging denial rates below 5% for 12 consecutive months qualify for Gold Card status, waiving prior authorization for routine imaging
Kansas Medicaid (KanCare)
Auto-detectableemergency bypass
Emergency imaging at CAH/REH facilities does not require prior authorization under KanCare. Retrospective review within 72 hours.
UnitedHealthcare
Auto-detectablemodified criteria
UHC applies modified clinical criteria for facilities in HPSAs and MUAs, accepting alternative imaging modalities when the standard modality is unavailable locally
CT CAP w/ contrast
DEMO-1 · Demo Patient · CPT 74176
MRI lumbar spine without contrast
DEMO-2 · Demo Patient · CPT 72148
When MRI is not available within clinically acceptable window, draft justification tying CT + US approach to guideline-consistent care (demo text).
Estimated net (demo): $1,137,120 after denial rate and rural adj.
Model shifts between Medicare, Medicaid, and commercial share — demo visualization placeholder.
Align high-yield imaging schedules with REH payment mechanics (conceptual demo).
