Protego’s browser extension sits alongside your RCM team as they work, and reads the claim inputs that determine coverage - payor, procedure, diagnosis and more. Using the same engine that generates appeals, our software cross references those inputs against coding initiatives and medical policies, flagging issues before claims are submitted, and preventing denials.
1.
BROWSER EXTENSION
Protego’s browser extension sits within your workflow, reading key details as you generate claims (payor, procedure, diagnosis, units, POS, etc).
2.
AI-powered rules engine
In real-time, Protego runs those input combinations against our internal rules engine, which draws upon medical policies, coding initiatives, payment criteria, and your own internal rules.
3.
Denial Prevention
Protego identifies potential issues before you submit claims, and exposes it’s internal logic so you can understand how it makes its decisions. Protego empowers RCM teams to navigate complex guidelines with confidence, staying ahead of policy changes that impact reimbursement.
Once you upload your denial, Protego surfaces and references the relevant policies, as well as the key components from the progress note. With the click of a button, your team can automatically generate a claim-specific appeal, reducing the time it takes to research and file appeals by up to 91%.
1.
Data extraction
Protego can extract key details from the denial, including the payor, the procedure, the diagnosis, and the denial codes.
2.
policy cross-referencing
Protego surfaces and cross references the policies and guidelines related to your denial to help determine if it’s valid. If the denial is incorrect, generating an appeal on the basis of those policies will ensure that your appeal is undeniable, and won’t be clawed back at a later date.
3.
Data anaylsis
Protego analyzes the relevant progress notes and clinical data, and cross references them with the policies/coding guidelines as outlined in the previous step. We can acquire supporting documentation via upload, data-dump, or direct integration.
4.
Appeal Generator
After Protego ingests the relevant details of the case in steps 1-3, our software generates appeal letters, citing the policies and record where relevant for you to download or submit directly to the payer.
Denied claims are the most time consuming and expensive part of revenue cycle management. Resources are limited, and time is valuable, which is why provider groups use Protego Health to fight their denials on contingency, paying us only for the cases we win. We have recovered hundreds of thousands of dollars in denied claims for provider groups.
1.
Denial selection
Select denied claims/denial types that you want Protego to address on your behalf.
2.
Working denials
Our in-house experts, using our AI-powered tools, will analyze your denials and file the necessary appeals to get you paid, following up as needed.
3.
collaboration
We win when you win - we are paid on contingency, ensuring our incentives are fully aligned.
In addition to being certified HIPAA compliant by Accountable, we use the Zoho CRM (SOC II Type 2 Compliant), where all provider data is uploaded and stored.
By preventing denials and automating appeals for wrongfully denied medical claims, Protego helps ensure denials are resolved before they burden patients and providers. Health plans use complex algorithms to deny claims, forcing RCM specialists to manage a time-consuming, manual appeals process.
Protego empowers RCM teams with tools to prevent denials where possible, and efficiently challenge them when they occur
Protego Health
Manhattan, New York
