Every day, prior authorization systems make decisions that harm patients. Not through malice—through mechanics.
Necessary care denied. A patient with an FDA-approved device gets rejected because the CPT code doesn't match an outdated ruleset. Treatment delayed. Condition worsens. The system said no when it should have said yes.
Unnecessary care approved. A patient gets an interspinous spacer they don't need because the codes aligned, even though the clinical picture didn't support it. Money spent. Risk incurred. No benefit delivered.
Both sins happen for the same reason: current systems are rules-based pattern matchers. If CPT code X plus diagnosis Y, approve. If not, deny. Zero clinical context. Zero reasoning. Zero accountability.
Yinsen replaces rules-based pattern matching with clinical reasoning.
When a prior authorization request comes in, Yinsen doesn't just check codes. It reads the clinical case. It understands symptoms, duration, imaging findings, prior treatments. It evaluates against evidence-based guidelines—the same guidelines a physician would use—and determines whether the requested care is appropriate for this patient, not just this code.
When the answer is yes, Yinsen approves—with full documentation of why.
When the answer is no, Yinsen explains—with specific criteria that weren't met and what alternatives might be appropriate.
When the answer is unclear, Yinsen flags it—identifying gray zones, red flags, and cases that need human review rather than forcing a binary decision.
Most importantly: Yinsen catches the twin sins before they happen. It recognizes when rules-based logic would deny appropriate care or approve inappropriate care—and intervenes.
In initial testing across lumbar spine procedures:
Cases that would have been wrongly denied by rules-based systems were correctly approved. Cases that would have been wrongly approved were flagged for review. Emergency cases were expedited. Gray zones were identified rather than forced into false certainty.
Smarter utilization management that reduces unnecessary care AND ensures necessary care isn't blocked. Lower costs through precision, not denial. Better outcomes because the right patients get the right treatments.
Transparent reasoning instead of black-box denials. When Yinsen disagrees, you know exactly why—and you can respond with evidence. Peer-to-peer review becomes a conversation about clinical merit, not a battle over codes.
The right care at the right time. No unnecessary procedures. No inappropriate delays. A system that actually looks at your case instead of just your codes.
Yinsen is the first layer of something bigger.
Once you have an intelligence layer that can reason over clinical cases, you can start building the infrastructure healthcare actually needs: care pathways as testable hypotheses. Outcome tracking linked to decisions. Variation measurement that identifies what actually works. Value curves for every patient journey.
A healthcare system that cannot measure outcomes per dollar spent, in real-time, has no moral authority to decide what care should or should not happen.
Yinsen is how we start measuring.
We're looking for self-funded employers ready to pilot Yinsen on a single condition vertical. No disruption to current workflows. No commitment beyond the pilot. Just a clear-eyed look at what's possible when prior authorization actually reasons.