ARMOR is a unique and proprietary service that runs seamlessly before the TPA software processes claims to prevent overpayments related to medical coding errors. This service is much different than licensed scrubbing software that has a license cost model that does not report and achieve the savings at the rate ARMOR can. ARMOR contains specific algorithms and unique code edits that save self-funded payers from overcharges up front. Other areas of differentiation are as follows:
The key differentiator is that CCAR provides three (3) audits that generate more cost savings than just the one traditional plan audit as the following highlights
There are many kinds of audits. Traditional benefit audits, RX audits, Dependent Audits, DRG audits, Financial Audits, etc. The healthcare traditional benefits audit only reviews processing errors to how the claims are being paid pursuant to the plan document. LJB has added unique medical claims data mining to the traditional benefits audit that will identify conditions that traditional audits do not. We also add a medical code audit that is unique and customized by analyzing every claim and every related claim with over three million edits. Another additional and unique audit feature we add to a traditional audit is our Anomalies Audit, which utilizes our proprietary analytics tool, ARMOR. ARMOR finds irregularities that cause overspending. Our LJB Medical Cost Repository is part of the Anomalies Analysis which adds a unique approach to flush out high cost procedures where your discounts are found not to be in line with the industry norms or trending cost that is out of control like a procedure occurrence reducing over the same time period that the cost was increasing for that procedure as an example. Specialty Drugs are the fastest growing medical cost component and normally found on medical claims (unlike typical prescription drugs going thru your PBM for discounts) and we focus on that issue specifically.
The following are more areas of differentiation only CCAR Audits provide:
Remediation of combined overspending findings creates a perpetual savings much larger than just trying to recovery past issues from a one year period. Combined outcomes will influence new cost savings programs and plan design modifications.
CCAR Outcomes Monitoring Service
LJB offers an Outcomes Monitoring Service (OMS) to rerun future paid claims on a bi-annual or annual basis. This service ensures the overspending identified in CCAR is being remediated by the administrator and will highlight any new areas of concern forthcoming. Additional or new areas of concern like disease cost trending can be monitored to set off alarms at predetermined thresholds. OMS can also monitor the effectiveness of a cost containment programs like a wellness program, etc.