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Protego Health

Protego Health

Protego Health

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Overview


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Avia Summary

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Protego Health is a solution provided by Covered Health. It belongs to multiple categories of digital health solutions including Revenue Cycle Management (RCM) and Payer Intelligence.
DESCRIPTION

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.

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Product capabilities

Denial Management and Prevention

Using inputs from claims and ERA’s, Protego finds and surfaces the relevant policies, cross references the progress note, and generates claim-specific appeals up to 91% faster.

AVIA GUIDE
What is denial management and prevention?
Identifies root causes of denials through pattern analysis Offers workflow tools for efficient denial follow-up and appeals Provides education and training to prevent future denials Example: A denial management module that categorizes denials, assigns them to appropriate staff, and tracks appeal outcomes.
EHR integration

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Use cases and differentiators

A hopsital or specialty provider group is struggling with denied medical claims, and wants a solution to help reduce the human capital required to overturn them. We are primarily working today with outpatient claims, but are in pilot discussions with several hospitals as well. 

This is relevant across specialties 

- RCM team

- CFO/COO

None provided

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?

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Reviewer’s Role
  • End user
  • Project manager
  • IT / Technical support
  • Executive sponsor
  • Internal consultant
  • Other

Reviewer’s Org Size
  • XL ($5B+ NPR)
  • L ($3-5B NPR)
  • M ($1-3B NPR)
  • S ($0.2-1B NPR)
  • XS (< $0.2B NPR)

Reviewer’s Org EMR compatibility

Reviewer’s Org Type
  • AMC
  • Pediatric Facilities
  • ACO
  • Rural Presence

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