Protego Health is a platform that automates the process of preventing and, when necessary, appealing denied medical claims for healthcare providers. By cross-referencing payer policies, billing/coding guidelines, and medical records, it can utilize AI to identify problems before them become denials, rectify denials, and generate appeal letters.

Patients placed in the wrong bed status with improper documentation results in massive revenue loss and patient dissatisfaction.

Physicians can’t keep up with constantly changing criteria needed to admit patients to the hospital, and hospitals spend tons of money and resources fixing bed status issues retrospectively.

AdmissionCare provides the admitting physician with automated admission criteria - such as MCG - integrated directly into the EHR workflow to help document medical necessity that increases payer reimbursements and reduce denials.

How does it work?

• Integrate into the clinician's EHR workflow
• Determine the most appropriate bed status for each patient at admission
• Synchronize payer criteria with the clinician's documentation
• Collect revenue for the care provided, while avoiding costly denials

EvidenceCare is a unique type of clinical decision support system (CDSS) with its EHR-integrated and content-agnostic platform that empowers better care decisions by improving clinical workflows.

Founded in response to the professional experience of emergency physician Dr. Brian Fengler, the platform provides clinicians with evidence-based insights and measurable outcomes that improve hospital margins.

Based in Nashville, Tennessee, EvidenceCare is a 2x honoree of the INC 5000 list of fastest growing companies, a 2x Fierce Healthcare Best Product winner, and one of Modern Healthcare's Best Places to Work in Healthcare.

Prevention and Appeal in the same engine: Protego's intelligencs pulls together billing/coding guidelines and specific payer policies. Using that technology, we can prevent denials at the point of claim creation by reading claim inputs in real time, running them against those rules, and flagging potential errors. On the back end, since some denials are inevitable, we can automate the appeals using that same intelligence engine. 

Incumbent RCM software companies: Move slowly, denials not a core focus area, and with older solutions, the tech is not easy to use or modernize. Our sole focus is excellence in the prevention and addressing of denials. 

New Entrants / Direct Competitors: Very new, and in a fragmented physician market, there are billions of dollars in denials to attack. Our focus is on the truth. What does the payer say they will cover, and how does that match up to what was done?

EHR Integrated on the front end of the clinician workflow

EHR Integrated on the front end of the clinician workflow