Arc Care sits at the intersection of utilization review, clinical decision support, and revenue cycle optimization — built end-to-end for hospitals and health plans.
Applies structured clinical criteria across inpatient admission, observation vs inpatient, continued stay, discharge readiness, and outpatient requests. Generates approval/denial recommendations and level-of-care decisions (IP, OBS, OP).
Ingests clinical data, orders, labs, vitals, and imaging — continuously evaluating cases as they evolve.
Evaluates outpatient and surgical requests with indications, contraindications, urgent vs elective logic, site-of-service rules, and required documentation checks.
Special criteria pathways for trauma, acute deterioration, and time-sensitive interventions.
Identifies high-risk cases for denial, documentation gaps, and criteria mismatches.
Structured outputs for utilization review notes, admission justification, continued stay, and discharge rationale.
Builds submission-ready documentation packets for prior authorization, concurrent reviews, and retrospective reviews.
Identifies out-of-network cases and scores approval likelihood based on medical necessity, network gaps, and case complexity.
MDs can override AI recommendations with clinical rationale, structured justification, and citation support.
Tracks approval/denial rates, length-of-stay trends, criteria adherence, and financial impact.
End-to-end case management across the entire continuum of care — admission, concurrent stay, discharge planning, transitions of care, and post-acute follow-up — unified in a single workflow alongside utilization review.
Not ready to give up control? Arc Care can be white-labeled and tailored to your organization post-pilot and upon contract — your brand, your domain, your workflow language, on top of our engine.