Protego Health is an AI-powered denial protection solution for healthcare providers, hospitals, and Revenue Cycle Management (RCM) companies. It automates the process of preventing and appealing wrongfully denied medical claims. The platform operates via a browser extension (Protego Copilot) that sits within the RCM workflow, allowing for use with or without costly EHR integration.
Denial Prevention: The AI-powered rules engine cross-references claim inputs (payor, procedure, diagnosis) against a comprehensive database of medical policies, coding guidelines, and the client's own rules. It flags potential issues in real-time before claim submission, drastically reducing preventable denials.
Automated Appeals: When a denial occurs, the Appeal Generator uses AI to extract key details, cross-reference relevant policies (LCDs, FDA guidelines, etc.), analyze progress notes, and automatically generate a claim-specific appeal letter. This process can reduce the time required to research and file appeals by up to 91% and boasts a reported 97% win rate on appealed denials.
Target Users & Benefits: The software is designed to boost RCM staff productivity, improve collection rates, and reduce the administrative burden on providers. Target users include Ambulatory Practices, Hospitals/Health Systems, and RCM companies.