600 S. Magnolia Ave, Suite 250, Tampa, Florida 33606  |  info@protolytic.com

Proto-Link™ API

Proto-Link™ API brings a powerful analytics engine to your systems.  It instantly gives you recommendations based on CMS and each state's rules for both medical treatment and reimbursement. 

The API is the result of 5-years of R&D to create proprietary algorithms that evaluate thousands of complex rules and regulations. 

Benefits

  • Integrates all state rules into your platform.
  • Saves years of development. 
  • Helps you make decisions in far less time. 
  • Instant recommendations based on thousands of state rules.  
  • Easily accessed through a dedicated application programming interface. 
  • Saves time for users. 
  • Cost effective licensing. 
  • Ability to customize rules based on company policies. 
  • Supports medical decisions. 
  • Enables new revenue opportunities.

API – Inputs & outputs

Inputs for the API will typically include ICD-10 diagnosis codes, along with NDC drug codes, CPT-4 medical procedure codes and modifiers, HCPCS Healthcare Common Procedure Coding System codes, and relevant patient data. 

The API instantly returns to your system a recommendation and rationale for the treatment and reimbursement.

Summary of the rules for treatment & reimbursement


The Proto-Link™ API rules cover all 51 jurisdictions:
  • Adjudicates health care treatment for drug utilization, diagnostic testing, physical medicine, surgery, and other categories
  • Provides clinical reasoning for medical decisions to resolve disputes among provider, payer, and patient 
  • Evaluates all aspects of patient stage recovery: diagnosis, education, informed decision making, treatment parameter duration, active interventions, positive patient
  • Tackles the treatment of physical conditions that occur with the greatest frequency, or which require the most expensive treatments 
  • Covers all phases of an injury; acute, subacute, and chronic to ensure the proper treatments during the correct clinical stage
  • Identifies red flags that may suggest the presence of serious underlying medical conditions 
  • State mandated provider specialty and licensing requirements for specific products and services to prevent unqualified medical treatment
  • State mandated coding requirements for products and service as well as provider specialties to ensure proper coding 
  • State mandated non-reimbursable codes to flag improper billing 
  • State mandated maximum reimbursement allowances to reduce costs 
  • State mandated reductions in maximum allowable reimbursement based on modifiers/provider specialty for proper billing  
  • State mandated facility-specific coding and billing requirements to ensure proper treatment/billing 
  • CMS - National Correct Coding Initiatives (NCCI) to reduce excessive/incorrect products/services 

© 2021, ProtoLytic, LLC All rights reserved

Office:

ProtoLytic, LLC
Suite 250
600 S. Magnolia Avenue
Tampa, FL 33606