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ARKA ROI MODEL · CONSERVATIVE CASE
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.
← Back to home~$3.5M
recovered / yr in avoidable imaging denials
86%
of imaging denials are avoidable
<800ms
to score an order, in-flow, no extra click
35–40%
of orders auto-clear and never hit a queue
Modeled gross recovery: $4.12M / yr
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.
Modeled ARKA annual cost ($1.79M) vs. modeled gross recovery ($4.12M) at ~2.3× return.
Fewer than 1% of denied in-network claims are ever appealed.2
KFF 2023 ↗Physicians spend ~13 hours/week on prior authorization.5
AMA 2024 ↗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
94% of physicians report PA delays care; 78% report patients abandon treatment; physicians average ~13 hours/week on PA.
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.
