The LJB Group delivers two unique models of overpayment protection to self-funded healthcare entities.
One is a prospective service protection against overcharges. This service called, ARMOR, intercepts and identifies medical claim coding errors that cause overpayments prior to adjudication and payment. The savings to the plan sponsor (payer) ranges from 2%-6% of their medical spend and serves as a cost containment initiative.
The second overpayment protection model is called Comprehensive Claims Audit & Reporting (CCAR). This retrospective claims payment review combines three different audits that run independently and then cross reference identified issues to be synchronized for validation and remediation. The savings to the plan sponsor (payer) are over 500% more than a traditional audit.
CCAR can generate both overpayment refunds and perpetual savings by preventing future overspending of validated issues the Third Party Administrator (or ASO Insurance Carrier) has remediated due to CCAR findings and recommendations.
Contact us to discuss how we can expose overspending issues you may have and get started with your overpayment protection initiative for you healthcare spending.
Overview
Overpayments are common due to the many people and steps involved in the billing of medical claims.
The actual determination of the correct billing (payment) code is usually manual and selected from a corresponding diagnostic code and service rendered. This is very complex and wide open for error.
Most providers follow the national correct coding initiative (NCCI) which contains millions of billing code combinations and very complex guidelines (CMS, AMA, others) that you can now imagine how much can go wrong. The total medical coding edits exceed 20 million!
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