ARMOR is an overpayment protection service for medical claim overcharges before they are paid to become overpayments. ARMOR eliminates the pay and chase model of overpayment recovery due to medical coding errors that result in overcharges. ARMOR is the proprietary product solely developed and owned by The LJB Group, LLC.
Some ARMOR technology key features are as follows:
- Contains over three million medical coding edits which are run against each submitted medical claim line and compared to every other historical related medical claim line.
- Contains imaging cross check analysis to the nationally recognized NIA (National Imaging Associates) which identifies complex imaging overcharges.
- AMA / CMS compliant coding edits that are called the National Correct Coding Initiative (NCCI) which are also governed by the AMA and CMS.
- Contains an Appeals Self-Service Support reference feature that displays the supporting documentation from the medical coding governing sources (AMA, CMS, NIA) for fast access and easy explanation of identified coding errors.
- Multiple Error Determination Findings is a unique feature that can flag more than one coding error on the same claim line.
- Utilizes our proprietary Error Triage Algorithm to prioritize the best case error when multiple coding errors are identified on the same claim line.
- Edit Customization is another unique key feature that allows the calibrating of any edit or edit group to be turned on or off for all providers or just one provider. This customized approach allows for special circumstances to be overridden in cases where the TPA or a leased/owned network finds allowing a coding error beneficial to the payer.
- Time sensitive updates determine coding errors that cause overpayments. ARMOR™ updates its entire NCCI and MUE edit structure to be compliant with the CMS update every quarter.
- How do I know that ARMOR reduces overcharges for my healthcare spending before committing to this service?
- Our proof of concept test will prove ARMOR’s ROI up front by running 3-6 months of prior paid claims thru ARMOR and then calculating the future savings from factual overcharges identified by ARMOR that will be caught going forward.
- Will ARMOR cause employee issues like balance billing or anything negative?
- ARMOR does not negatively affect your employees and their healthcare at all. In fact, it will save your employee money from overpayments that affect their deductible, co-pay, and any out-of-pocket expenses that were overinflated due to miscoding to their medical claims.