Protego Health
Protego Health (Covered Health Inc) builds Guardian, an AI platform that embeds payer-specific policy intelligence into EHR workflows to prevent medical claim denials and automate payer-cited appeals for US provider groups, hospitals, and RCM companies.
- Company typePrivate
- Founded2023
- HeadquartersManhattan, United States
- Headcount11–50
- GTM typeB2B
- OfferingSoftware
What Protego Health does
Protego Health (legal entity Covered Health Inc) is a US-based, privately-held healthcare technology company that builds AI-driven revenue cycle management software for medical practices, billing teams, hospitals, and RCM companies. The company's flagship platform, Guardian, embeds payer-specific policy and coding intelligence directly into existing EHR workflows via a browser extension, flagging denial risks at the point of order, clinical note creation, and claim build before claims are submitted. When denials do occur, Guardian's Appeal Generator automatically drafts policy-cited appeals and the Batch Analyzer unifies open AR reporting across sites and EHR systems, transforming raw 835/837 data into prioritized work queues with payer-specific next steps.
Guardian's technology rests on a proprietary rules engine that continuously tracks LCDs, payer-specific policies, medical-necessity criteria, and adjudication behavior, combining structured claims data (CPT, HCPCS, ICD, modifiers, denial codes) with text from clinical documentation to produce real-time denial prevention and policy-backed appeal generation. The company is SOC 2 Type II certified and designed to support HIPAA compliance, and integrates with major web-based EHRs including AthenaOne, eClinicalWorks, ModMed, AdvancedMD, and gGastro. A public Guardian API additionally enables RCM companies to embed denial management and appeal automation into their own service offerings.
Protego Health sells through a direct enterprise field sales motion with quote-based annual subscriptions and a minimum 7-billing-provider threshold, primarily targeting provider groups, enterprise healthcare organizations, hospitals, and RCM companies in the United States. Pricing is not publicly disclosed, though the company reports operational metrics of up to 46% of denials prevented and up to 91% reduction in time spent researching, drafting, and submitting appeals. As of late 2025, the company is anchored by a flagship deployment with Ogden Clinic (Guardian Pro) and operates from Manhattan, New York, with mailing operations in Albany, New York.
Protego Health firmographics
Firmographics- Name
- Protego Health
- Legal name
- Covered Health Inc
- Website
- https://protegohealth.ai
- Company type
- Private
- Founded year
- 2023
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Short description
- Protego Health (Covered Health Inc) builds Guardian, an AI platform that embeds payer-specific policy intelligence into EHR workflows to prevent medical claim denials and automate payer-cited appeals for US provider groups, hospitals, and RCM companies.
- Ownership category
- akta.pro rank
Protego Health industry classification
Industry- Product category
- Healthcare Revenue Cycle Management Software
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Services-Prepackaged Software (7372)
- akta.pro primary industry
- Denials Management & Appeals (HLACACAH)
- akta.pro secondary industry
- Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)
Keywords
Where Protego Health is headquartered
LocationHeadquarters
- HQ city
- Manhattan
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Protego Health business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Marketing or Sales, Operations, Infrastructure, Others
Revenue model
- Software Subscription Services: AI-powered denial prevention and appeal generation tools delivered as SaaS. Pricing determined at time of service request for appeals. Guardian platform deployed via browser extension within web-based EHR workflows.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Annual | Enterprise and provider group pricing |
Go-to-market motion1 record
Distribution channels2 records
Marketing channels7 records
Protego Health product offering
Product offeringCore offering
Protego Health provides an AI-powered SaaS platform called Guardian that embeds payer-specific policy and coding intelligence directly into healthcare billing workflows to prevent medical claim denials at the point of order, clinical note, and claim creation. When denials occur, the platform automatically generates policy-backed appeals citing the exact payer language and documentation required, and its Batch Analyzer unifies open accounts receivable reporting across sites and EHRs. The solution is delivered as a browser extension that integrates with web-based EHR systems without rip-and-replace implementations.
Product overview
Protego Health offers an AI-powered revenue cycle management platform called Guardian, consisting of three integrated modules. Guardian Denial Preventer flags coding and policy violations before claims are submitted; Guardian Appeal Generator automates creation of payer-specific appeals when denials occur; and Batch Analyzer unifies AR reporting across sites and EHRs with actionable next steps. Guardian Pro is the enterprise tier of the platform. The system embeds real-time payer policy intelligence directly into billing workflows via browser extension and EHR integration to prevent denials and streamline appeals.
Differentiator
Problem solved
Functional benefit
Brands
- Guardian: AI-powered platform for denial prevention and appeal generation, including Guardian Denial Preventer, Guardian Appeal Generator, and Batch Analyzer tools
Products and services
- Guardian Denial Preventer AI-powered denial prevention tool that flags denial risks at the point of order, clinical note, and claim creation. Validates diagnosis-procedure pairings against LCD and payer policies in real time, surfaces medical necessity requirements, and recommends payer-specific fixes before claim submission. Targeted at physician practices, hospitals, and RCM billing teams.
- Guardian Appeal Generator Automated appeal creation tool that extracts denial details, cross-references individual payer policies and coding guidelines, and generates claim-specific appeals citing policy language and clinical evidence. Enables billing teams to research and appeal complex denials up to 91% faster. Targeted at physician practices and RCM billing teams.
- Batch Analyzer AR analysis tool that unifies open accounts receivable reporting across sites and EHRs by transforming raw 835/837 data into structured work queues. Organizes unpaid claims by payer, age, category, or amount with payer-specific next steps and surfaces denial violations with actionable fixes. Targeted at multi-site healthcare organizations.
- Guardian Pro Enterprise-tier deployment of the Guardian platform with AI-driven denial prevention and appeal automation for revenue cycle management. Includes API-based integration for RCM companies to embed the software in existing workflows. Expected outcomes include preventing up to 43-46% of denials and reducing appeal time by up to 91%.
Quantifiable outcome
- Up to 46% of denials prevented
- +5 more outcomes
Companies that use Protego Health
Customer profileNamed customers2 records
Segments4 records
Ideal customer profiles4 records
Protego Health technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration5 records
AI capability6 records
Feature4 records
Protego Health partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- Ogden ClinicflagshipStrategic partnership with Ogden Clinic, a large medical group in Utah, to implement AI-driven solutions for revenue cycle management. Deployment of Protego's Guardian Pro platform aimed at reducing denials and streamlining appeals. Expected outcomes include preventing up to 43% of denials and reducing time needed for appeals by up to 91%. Focus on enhancing financial performance and administrative accuracy in healthcare operations.
Scale indicators5 records
Recent moves6 records
Expansion highlights5 records
Protego Health competitors and assessment
Company assessmentDirect peers
- Candid Health: AI-powered RCM platform focused on autonomous claims processing and denial management for provider groups and digital health companies. Comparable to Protego because it applies AI directly to claims and denials workflows for similar provider buyer segments, with a similar AI-native positioning.
- Anterior: AI-native platform focused on prior authorization and clinical denial management for healthcare providers. Directly comparable to Protego because it targets the same upstream administrative pain point (denials driven by payer policy friction) using AI applied to clinical and claims data, and sells into similar provider and RCM buyer segments.
- AKASA: AI platform for revenue cycle automation across authorization, claims, and denials for hospitals and health systems. Comparable to Protego because it applies AI to the same denial-and-appeal workflow and serves enterprise healthcare organizations struggling with preventable denials and AR backlog.
- Infinx: Revenue cycle and prior authorization company offering AI-enabled patient access and claims management for hospitals and specialty practices. Comparable to Protego because it directly competes in denial prevention and appeals automation, with overlapping specialty practice and hospital buyer segments.
Emerging players
- SmarterDx: AI platform that reviews clinical documentation and coding to prevent revenue leakage and identify missed diagnoses for hospitals. Comparable to Protego because it operates in the same upstream clinical-to-claim workflow where errors lead to denials, though its focus is on coding accuracy and CDM optimization rather than payer-policy-driven denials.
Broad incumbents
- Experian Health: Established RCM and patient access suite covering eligibility, claims, denials, and identity management for hospitals and physician groups. Comparable to Protego because it competes in the same denial-management space, but as a much broader portfolio product targeting the same hospital and provider buyer.
- Availity: Healthcare information network connecting payers and providers, with revenue cycle and denial management capabilities built on top of its payer-provider data exchange. Comparable to Protego because it handles claims data (X12) and denial workflows, but as a much larger incumbent with deep payer relationships.
- Waystar: Large, established cloud-based RCM platform covering claims management, denials, patient estimation, and payment processing for hospitals and providers. Comparable to Protego because it addresses denial management and appeals as part of a broader RCM suite, but it is a much larger incumbent with embedded payer relationships and an installed base Protego must compete against.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Protego Health social profiles
Digital presenceProtego Health compliance and trust
Trust signalCompliance2 records
Protego Health financial estimates
Financial estimateRevenue estimate
Valuation estimate
Protego Health leadership team
Management profileNumber of profiles
Profiles4 records
Protego Health funding detail
Funding detailFunding overview
Funding rounds1 record
Investors1 record
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Protego Health M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Protego Health
What does Protego Health do?
Protego Health provides an AI-powered SaaS platform called Guardian that embeds payer-specific policy and coding intelligence directly into healthcare billing workflows to prevent medical claim denials at the point of order, clinical note, and claim creation. When denials occur, the platform automatically generates policy-backed appeals citing the exact payer language and documentation required, and its Batch Analyzer unifies open accounts receivable reporting across sites and EHRs. The solution is delivered as a browser extension that integrates with web-based EHR systems without rip-and-replace implementations.
Is Protego Health a public or private company?
Protego Health is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Protego Health founded?
Protego Health was founded in 2023. It employs 11 to 50 people.
Where is Protego Health based?
Protego Health is headquartered in Manhattan, United States, in the North America region.
How does Protego Health make money?
One revenue line is on record: software Subscription Services.
Who are Protego Health's main competitors?
Direct peers on record are Candid Health, Anterior, AKASA and Infinx. SmarterDx is listed as an emerging player. Broad incumbents are Experian Health, Availity and Waystar.
Does Protego Health have an API?
Yes. Protego Guardian is built on APIs to allow RCM companies to utilize the software for denial management. The API enables RCM companies to integrate the software into their existing workflows.
What industry is Protego Health in?
Protego Health's product category is Healthcare Revenue Cycle Management Software. Its primary akta.pro industry code is HLACACAH, Denials Management & Appeals, with a secondary code of HLACABAK, Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment). Its NAICS code is 524292 and its SIC code is 7372.