Smart decisioning
in pre-authorization.
SIT turns health insurance companies' daily pre-authorization workload into an AI-supported decision flow. In the traditional flow, every application is read by hand and decided through file back-and-forth; SIT moves the bulk of this process to the AI agent layer. The specialist's time stays on critical decisions.
Two sides of the same case,
seen at the same time.
Health pre-authorization is not a hospital-only or insurance-only process — it is friction between the two. Opinion AI reduces that friction with a shared evaluation protocol: the hospital prepares the application through TIS, and the insurer evaluates the same case in SIT. Each side keeps its own data in-house — nothing is transferred to Opinion AI. Both work from the same document, the same clinical summary and the same AI score.
Hospital Side
Runs with the AI agent MINA and the audit simulator MINA Cockpit. The operator prepares the pre-auth; missing documents are flagged in advance. Before submission, the application reaches "ready for insurer" state.
Insurance Side
Runs with the AI agent MINA and the insurance cockpit MINA Cockpit. The specialist evaluates the same application; approves, asks for missing documents or rejects with a single click. Rationale flows back to the hospital automatically.
No double data entry
The hospital uploads once; the insurer reads the same data. The phone-fax-email chain disappears. Document loss becomes impossible.
Same AI score on both sides
Clinical fit, reimbursement compliance and file completeness scores are visible to both sides. The hospital is not surprised by "why was I rejected"; the insurer is not chasing missing documents.
Hours to minutes
MINA performs the pre-assessment the moment a file is uploaded; the specialist only confirms. The hospital operator usually gets the approval notice the same day.
Appeal loop closes
For rejected files, the rationale with reason code flows back to the hospital. If a single document is missing, the hospital adds it directly via SIT; the file is re-evaluated.
The clinical brain of insurance:
MINA.
SIT places MINA's clinical AI directly into the insurance specialist's workflow. MINA supports file-level decisions; at the portfolio level, MINA Cockpit delivers an actuarial view and audit simulation.
File-Level Decision Support
For the insurance specialist. Reads documents, records vitals/labs, checks reimbursement fit, evaluates the application, surfaces similar cases, suggests a decision, requests additional info, cites clinical guidelines. Decision approval always stays with the specialist.
Portfolio-Level Audit
For the insurance manager. Looks not at a single file but at the portfolio. Predicts before official audit and actuarial reporting; how many active cases, how many high-value, how many at rejection risk — critical indicators surface as above-threshold alerts.
For provision and claims assessment, MINA v3.7 measured 0.93 fraud-detection AUC, 95% policy-coverage accuracy and 91% SUT decision accuracy; citation hallucination dropped to 0.3%.
The same clinical intelligence,
two independent deployments.
Opinion AI is neither a hospital nor an insurance system, and it does not sit between the two. TIS runs inside the hospital, SIT inside the insurer — each a separate deployment that keeps its own data in-house. When both evaluate the same case with the same clinical intelligence, decisions rest on a shared basis instead of competing versions of the truth.
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