Protego Health

Protego Health provides AI-driven software tools designed to help healthcare provider billing teams prevent and appeal denied medical claims. The company's platform addresses the estimated $20 billion annually that providers spend pursuing denied and delayed insurance claims by automating denial prevention and appeal generation processes.

The company offers four primary services: a web extension that flags potential denial issues before claim submission by cross-referencing payor policies and coding guidelines; an appeal generator that creates claim-level appeals by analyzing ERAs, medical policies, and clinical documentation; a reference tool for verifying medical necessity and prior authorization criteria; and denial services where Protego's team manages appeals on a contingency basis. The platform reports a 97% win rate on appealed denials and claims to reduce appeal research and writing time by 91%.

Protego Health serves outpatient practices, surgery centers, and physician groups across specialties including ophthalmology and gastroenterology. Customer testimonials come from RCM professionals at organizations ranging from 28-provider independent groups to 40-physician outpatient facilities.

Consider Protego Health if your practice is struggling with high denial rates and your billing team spends significant time manually researching payor policies and writing appeals. The platform is designed for organizations seeking to augment existing RCM staff capabilities rather than replace them.

Expect a tool-based approach that requires your team to actively use the software within their current workflows. The contingency-based denial services option may appeal to practices wanting to test effectiveness before committing to full platform adoption.

Protego Health serves exclusively healthcare providers in the medical claims and revenue cycle management space. The platform is built specifically around healthcare-specific databases including payor medical policies, Local Coverage Determinations (LCDs), FDA guidelines, and CPT coding initiatives. Customer testimonials reference specialty practices in ophthalmology and gastroenterology, indicating experience with specialty-specific billing complexity.

The company positions its solution as addressing the asymmetry where health plans use technology to adjudicate and deny claims while providers have relied primarily on manual processes to prevent and appeal those denials.

The ideal client is a physician practice, specialty group, or ambulatory surgery center with 10-50 providers that experiences frequent claims denials and has dedicated billing staff capable of adopting new software tools. Organizations in specialties with complex medical necessity requirements or frequent prior authorization challenges—such as ophthalmology, gastroenterology, or surgery centers—appear to be the primary target market.