Protego Health
Enterprise
Overview
Protego Health offers an AI-powered platform designed to assist healthcare providers and revenue cycle management (RCM) teams in preventing and appealing denied medical claims.
- What it does: The platform, primarily through its “Guardian” tool, provides real-time denial prevention by checking claims against payer policies and coding initiatives during order creation, clinical note documentation, and claim generation. It also features an automated appeal generator that drafts appeal letters by cross-referencing ERA data, payer policies, clinical notes, and guidelines.
- Who it is for: Protego Health is intended for physician practices, hospitals, health systems, and RCM companies. Typical users include AR specialists, revenue cycle managers, and billing teams.
- How it fits a clinical or practice workflow: The Guardian tool operates as a browser-based web extension that embeds directly into existing web-based clinical and billing workflows, eliminating the need for traditional EHR integration. This allows for real-time flagging of potential issues and recommendations for payer-specific fixes before claim submission.
- Notable capabilities: Key features include real-time claim scrubbing for denial prevention, automated appeal generation, and a reference tool that surfaces medical necessity and prior authorization criteria. The platform continuously updates its rules engine with regulatory guidance and individual payer policies.
Reviewed by Pouyan Golshani, MD — Interventional Radiologist
Key Features
- AI-Powered Denial Prevention (Real-time claim scrubbing)
- Automated Appeal Generation (Up to 91% faster)
- Browser Extension (Protego Copilot) for RCM workflow integration
- Policy Cross-Referencing (Payer policies, LCDs, Coding guidelines)
- Data Analysis of Progress Notes for Clinical Appeals
- Reference Tool for Medical Necessity/Prior Auth Criteria
- Actionable analysis of unpaid claims
- Continuous payer intelligence
- Human in-the-loop design
Use Cases
- Real-time denial prevention at the point of note and claim creation
- Automated appeals generation for denied claims
- Claim-level corrective actions across payers for AR management
- Reducing administrative burden on providers and RCM staff
- Optimizing appeal strategies using historical denial data
- Fighting for recoverable dollars in hospitals
What Physicians Need to Know
Key Capabilities
Protego Health offers AI-powered denial prevention and automated appeals generation for medical claims. It provides real-time claim scrubbing, cross-referencing claim inputs against a comprehensive database of medical policies, coding guidelines, and client-specific rules to flag potential issues before submission. The platform also automatically generates appeal letters by extracting key details, cross-referencing relevant policies, and analyzing progress notes.
Clinical Utility
The tool aims to reduce preventable denials by up to 42-46% and can decrease the time required to research and file appeals by up to 91%. This improves collection rates, boosts RCM staff productivity, and reduces the administrative burden on providers. It supports all specialties and is designed for ambulatory practices, hospitals/health systems, and RCM companies.
Integration Options
Protego Health's Guardian platform operates as a browser-based real-time web extension, embedding directly into existing web-based clinical and billing workflows without requiring complex EHR or clearinghouse integrations. It can also integrate with RCM systems via API and offers optional EHR/EMR system integration.
Compliance Status
Protego Health is SOC 2 Type II certified and designed to support HIPAA compliance requirements.
Pricing Model
Protego Health uses a per-provider per-month pricing model, aligning costs with the size of the customer's clinical footprint. Pricing is not publicly disclosed and is structured for enterprise clients.
User Experience
The platform is designed to be user-friendly, embedding into existing browser-based workflows so billers, coders, and providers interact with Protego within the tools they already use. It provides real-time feedback and corrective guidance, with a human-in-the-loop design where staff make the final decisions on claims and appeals.
Support Quality
Protego Health offers a 'white-glove service' for clients who wish to offload their accounts receivable using in-house experts and AI-powered tools. They also provide support via email.
Implementation Complexity
Implementation is designed for rapid, low-lift deployment, with most products operational within minutes and teams averaging only 30 minutes of initial training. There is no traditional EHR or clearinghouse integration required, significantly reducing IT burden.
Evidence Base
Protego Health reports documented reductions of up to 42-46% in denials and up to 91% time saved in researching, drafting, and submitting appeals. They cite sources like Premier and MGMA regarding denial rates and appeal costs. A case study showed a 46.5% reduction in coding denials for a multi-specialty practice. The company was founded in 2023.
Physician Tip
Protego Health's real-time denial prevention, embedded directly into your existing web-based EHR workflow, can significantly reduce administrative burden and improve revenue capture. Focus on utilizing the proactive guidance to address coding and policy issues before claim submission. While the AI automates much of the appeal generation, remember that your team retains final decision-making authority, ensuring clinical oversight. The rapid implementation and minimal IT involvement mean you can see benefits quickly without major disruptions.
Protego Health's primary integration method is a browser extension that works within existing web-based EHRs and billing workflows, eliminating the need for complex, time-consuming technical integrations. While direct EHR integration is optional, the browser extension provides real-time functionality without requiring changes to your current systems. This 'no-integration deployment' approach is a key differentiator, allowing for quick time-to-value.
Details
| Category | Medical Billing & RCM, Prior Authorization |
| Pricing | Enterprise — Per provider per month |
| Deployment | Multi-tenant SaaS; Browser Extension |
| Compliance | |
| BAA Available | Unknown AI-estimated |
| HIPAA Compliant | Unknown AI-estimated |
| FDA Status |
Unknown AI-estimated Protego Health is not a medical device and therefore does not require FDA clearance. Its AI tools cross-reference FDA guidelines as part of its automated appeals process. |
| Integrations | |
| EHR | Not specified |
| Specialties | Family Medicine, Hospital Medicine, Internal Medicine |
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Videos
Product demos, reviews, and walkthroughs for Protego Health.
Using AI to Prevent and Appeal Healthcare Denials with Protego Health's Corey Feldman
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Showcase
Frequently Asked Questions
Protego Health's RCM solution is designed for seamless integration with most major EHR and practice management systems through secure APIs. This allows for automated data exchange, reducing manual entry and potential errors in your billing workflow.
Protego Health prioritizes compliance through robust data encryption, access controls, and regular audits to meet HIPAA standards. Our RCM processes are also designed to align with Stark Law and Anti-Kickback Statute guidelines, with ongoing monitoring for regulatory changes to ensure continuous adherence.
Common alternatives include in-house billing teams, other third-party RCM vendors, and hybrid models. Protego Health differentiates itself through its AI-driven predictive analytics for claim denial prevention, a dedicated team of certified coders and billers, and transparent, performance-based pricing models.
Protego Health offers a transparent, tiered pricing structure typically based on a percentage of collections, with no hidden fees. Our contracts are designed to be flexible, often including options for month-to-month or annual agreements, and all terms are clearly outlined upfront.
While Protego Health supports a broad range of specialties, limitations may arise in extremely niche fields requiring highly specialized coding knowledge not commonly encountered. However, we offer customizable solutions and can often bring in expert resources for complex or unique billing scenarios.
Protego Health employs a proactive approach to claim denials, utilizing advanced analytics to identify and address potential issues before submission. For denied claims, our dedicated appeals team meticulously reviews each case, prepares comprehensive documentation, and has a strong track record of successfully overturning denials, with a typical success rate exceeding industry averages.
Protego Health provides comprehensive, customizable dashboards and reports offering real-time insights into key RCM metrics such as collection rates, denial trends, and days in A/R. These analytics help identify bottlenecks, optimize workflows, and improve overall financial performance.
The onboarding process typically involves an initial assessment, data integration, and staff training, usually completed within 4-6 weeks depending on the complexity of your existing systems. Our team provides dedicated support throughout the transition to ensure a smooth and efficient setup.
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| Last Verified: 2026-09-09 | First Added: 2026-09-09