Protego Health provides an automated denial management platform that generates appeals for denied medical claims on behalf of provider organizations. The solution combines algorithmic analysis of past denials with expert‑driven recommendations, and can be delivered as software for internal revenue‑cycle teams or as a full‑service offering. The company operates on a pay‑per‑success model, receiving fees only when a claim denial is successfully overturned.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare providers spend significant time and resources appealing denied medical claims, costing the industry billions annually. The complexity of the appeals process and the increasing use of machine-driven algorithms by health plans to deny claims exacerbate this issue.
Solution
Covered automates the medical claim appeal process for healthcare providers using AI algorithms. The software analyzes previously denied claims and their appeal outcomes to recommend optimal next steps. This approach aims to reduce the time and resources providers spend on reversing incorrect denials, allowing them to focus on patient care and other critical tasks. Covered offers both a denial management product for in-house teams and a full-service solution.
Target Audience
Covered's primary customers are healthcare providers and provider organizations seeking to streamline their medical claim appeal process and reduce associated costs.
Features
- AI-powered analysis of denied claims and appeal outcomes
- Recommendation of optimal next steps in the appeals process
- Denial management product for in-house teams
- Full-service solution for complete outsourcing of the appeals process
- Pay-per-success model, ensuring payment only for successfully overturned denials