The decision engine for utilization and clinical care.
Arc Care replaces fragmented, manual review with real-time, criteria-based, data-driven approvals — every decision returned under nurse or MD oversight.
Utilization Review. Clinical Decision Support. Revenue Cycle.
Arc Care unifies what most systems silo — controlling cost, compliance, and clinical efficiency at the same time.
Bring your own clinical criteria. We'll still hit the SLA.
Industry-standard criteria, internal payer rules, or service-line specific pathways — plug your standards into Arc Care. The engine adapts, the 24-hour turnaround doesn't move.
What Arc Care actually does.
Medical Necessity & Level of Care
Structured criteria across IP, OBS, OP, continued stay, and discharge readiness — faster, more dynamic, and built for modern clinical workflows.
Real-Time Utilization Review
Continuously evaluates clinical data, orders, labs, vitals, and imaging as cases evolve — turning UR from reactive to proactive.
CPT / Procedure Engine
Indications, contraindications, urgent vs elective logic, site-of-service rules, and required documentation checks.
Trauma & Urgent Pathways
Single-criteria approval pathways for trauma, acute deterioration, and time-sensitive interventions — no unnecessary delays.
Denial Prevention & Risk Scoring
Likelihood-to-meet-criteria scoring with real-time recommendations to close documentation gaps before submission.
Auto-Generated Documentation
Structured UR notes, admission justification, continued stay, and discharge rationale — aligned with payer expectations.
Claims & Authorization Support
Submission-ready packets for prior auth, concurrent, and retrospective reviews — minimizing payer back-and-forth.
Single Case Agreement Engine
Identifies out-of-network cases and scores approval likelihood — direct submission from provider or nurse workflow.
Physician Override & Governance
MDs override AI with structured rationale and citations. Override patterns and provider variability tracked for compliance.
Analytics & Performance
Approval/denial rates, length-of-stay trends, criteria adherence, and financial impact — denials avoided, revenue protected.
Comprehensive Case Management
End-to-end case management across the continuum — admission through discharge and post-acute follow-up. Care coordination, transitions of care, and discharge planning, all in one workflow.
White Label & Brand Tailoring
Not ready to give up control? We can white-label the system tailored to you and your needs post-pilot and upon contract — your brand, your domain, your workflow language, on top of our engine.
Most UR systems describe the past. Arc Care decides the present.
- — Static, rule-book criteria
- — Manual chart interpretation
- — Retrospective review cycles
- — Siloed UR, CDS, and revenue cycle
- — Black-box outputs, weak audit trails
- + Dynamic, real-time decision engine
- + AI-assisted clinical reasoning
- + Continuous, proactive evaluation
- + Unified UR · CDS · revenue cycle
- + Citation-backed, fully auditable
Real-Time, Not Retrospective
Decisions evaluated continuously as orders, labs, and vitals stream in — not days after the fact.
Your Criteria. Our SLA.
Industry-standard or your own internal pathways — Arc Care adapts. The 24-hour SLA doesn't move.
Clinically Governed
Every recommendation gated by nurse or MD oversight. AI augments your team — it never replaces them.
End-to-End, Not Point-Solution
One engine spans medical necessity, denial prevention, documentation, claims, and SCAs.
Built for Audit
Every decision, override, and rationale is timestamped, citation-backed, and immutable.
Measurable Impact
75–85% less review time. 95–100% of cases returned within 24 hours. Tracked on day one.
Built for the entire continuum.
Not ready to give up control? Make it yours.
Arc Care can be fully white-labeled — your brand, your domain, your workflow language — tailored to your organization's needs post-pilot and upon contract. Keep your identity in front of providers, members, and reviewers while running on our engine underneath.
- Your brand, end-to-endLogo, color system, typography, and domain — applied across the reviewer console, provider portal, and outbound determinations.
- Tailored workflow languageDetermination phrasing, criteria naming, and notification templates configured to match your medical policy voice.
- Available post-pilot, upon contractWe prove value first on the standard Arc Care experience. White labeling is enabled as part of your production rollout.
Meet RideArc — non-emergency medical transportation, built in.
Our partner and sister company, RideArc, launches in November to close one of the most expensive gaps in member care: getting members to and from the appointments their plan already authorized.
RideArc can be added to any Arc Care contract as a turnkey member medical transportation benefit — fully integrated with utilization and case management workflows, so authorized care actually happens. Ask us about adding RideArc to your plan at any time.
More to come from Arc Care.
We're just getting started. New modules, new partners, and deeper integrations are rolling out across utilization, case management, and member services. Join now and grow with the platform — early partners shape the roadmap.
Control cost, compliance, and clinical efficiency.
See how Arc Care can transform your utilization workflow in under 30 days.
Request a Demo