The LJB Group, LLC

What The LJB Group, LLC does

The LJB Group, LLC is a privately held healthcare cost-containment firm headquartered at 6816 Southpoint Parkway, Building 600, Jacksonville, Florida, focused exclusively on medical claim overpayment protection for self-funded healthcare entities (employer plan sponsors and Taft-Hartley plans). Founded by Larry Longhi and Ben Balke, both veterans of healthcare IT and medical claims software, the firm operates with a staff of 1-10 and has been active since 2015, with the company website operating under that copyright year (note: one firmographics field lists the founding year as 2007, while multiple primary sources including the company timeline cite 2015; the 2015 date is used here per the most recent and most specific primary sources).

LJB's product portfolio centers on two proprietary, trademarked offerings: ARMOR, a prospective pre-payment claims editing service that intercepts 100% of submitted medical claims before adjudication and screens them against more than three million tested medical coding edits aligned with NCCI, AMA, and CMS guidelines, including imaging cross-checks against National Imaging Associates (NIA) standards; and CCAR (Comprehensive Claims Audit & Reporting), a retrospective three-audit methodology that analyzes 100% of a client's prior 24 months of paid claims through a Traditional Plan Audit, Correct Coding Analysis, and Anomaly Analytics. Underlying technology includes an Error Triage Algorithm that prioritizes the best-of-multiple coding errors on a single claim line, code-edit customization by provider, an Appeals Self-Service reference feature, and an LJB Medical Cost Repository for industry cost benchmarking. An add-on Outcomes Monitoring Service (OMS) reruns paid claims annually or bi-annually post-audit to verify remediation. The firm operates a Proof of Concept trial model in which prospects receive a free analysis of 3-6 months of paid claims to demonstrate ROI prior to commitment.

LJB monetizes through two distinct revenue streams: recurring subscription fees for the ARMOR pre-payment editing service and the OMS module, and project-based professional services fees for CCAR retrospective audits that generate overpayment refunds. Distribution is hybrid: a direct enterprise sales motion targets self-funded plan sponsors and payers, while channel partnerships with Third Party Administrators (TPAs) integrate ARMOR into claims-processing workflows via ClaimsBridge/Innovative Healthware Services EDI transaction management, and Trilogy Consulting Group serves as the on-site delivery partner for CCAR audits reaching marquee employer plans including Toyota, McDonalds, Wrigley, and Briggs & Stratton. Customer outcomes reported by LJB include 2%-6% medical spend reduction from ARMOR, $7.00-$10.00 PE/PM savings at a 2% error rate, and CCAR savings exceeding traditional audits by over 500%. No disclosed revenue, ARR, funding rounds, or institutional ownership appear in the source data.

Name

The LJB Group, LLC

Legal name

The LJB Group, LLC

Website

https://theljbgroup.com

Company type

Private

Founded year

2015

Operating status

Operating

Headcount range

1–10 employees

Short description

The LJB Group provides medical claims overpayment protection and cost containment for self-funded healthcare payers via its proprietary ARMOR pre-payment claims editing system and CCAR retrospective audit service, distributed through TPA channel partners and Trilogy Consulting Group.

Ownership category

akta.pro rank

Product category

Healthcare Claims Overpayment Protection / Cost Containment Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Claims Administration & Payment Integrity (Medical/Dental/Vision) (HLAEALAD)

akta.pro secondary industries

RCM Analytics, Benchmarking & Underpayment Detection (HLACACAL), Claims Management, Scrubbing & Clearinghouse (HLACACAB), Level-Funded Group Health Plans (FSAIAFAC)

Keywords

• Medical claims overpayment
• Healthcare cost containment
• Pre-payment claims editing
• Self-funded healthcare plans
• Medical coding audits

Headquarters

HQ city

Jacksonville

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Marketing or Sales, Operations, Infrastructure

Revenue model

1. ARMOR Service Fees: Ongoing service fees for pre-payment medical claim coding error interception. ARMOR intercepts and identifies medical claim coding errors that cause overpayments prior to adjudication and payment, generating savings of 2%-6% of medical spend for plan sponsors.
2. CCAR Audit Fees: One-time retrospective claims audit fees for analyzing 24 months of paid claims using three-audit approach (Plan Audit, Correct Coding Analysis, Anomaly Analytics). Generates overpayment refunds and perpetual savings from validated issues.
3. Outcomes Monitoring Service (OMS): Bi-annual or annual rerunning of paid claims on future claims to ensure overspending identified in CCAR is being remediated and to highlight new areas of concern.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels3 records

Core offering

The LJB Group provides medical claims overpayment protection and cost containment services for self-funded healthcare payers through two core models: ARMOR, a prospective pre-payment claims editing service that intercepts 100% of submitted medical claims against over three million coding edits before adjudication to identify errors and stop overpayments; and CCAR (Comprehensive Claims Audit & Reporting), a retrospective three-audit approach analyzing 24 months of paid claims to recover overpayments and identify systemic spending anomalies.

Product overview

The LJB Group offers two distinct cost containment products: ARMOR (a prospective pre-payment claims editing service) and CCAR (a retrospective three-audit approach covering prior 24 months of claims). ARMOR intercepts 100% of submitted medical claims pre-adjudication to identify coding errors, while CCAR combines Traditional Plan Audit, Correct Coding Analysis, and Anomaly Analytics for comprehensive claims review. Optional add-on modules include the Outcomes Monitoring Service for ongoing monitoring and a Proof of Concept Trial for prospective clients.

Differentiator

Problem solved

Functional benefit

Brands

• ARMOR: A proprietary overpayment protection service for medical claim overcharges before they are paid. ARMOR intercepts and identifies medical claim coding errors that cause overpayments prior to adjudication and payment.
• CCAR

Products and services

• ARMOR ARMOR is a proprietary overpayment protection service that intercepts 100% of submitted medical claims pre-adjudication, analyzes them against over three million medical coding edits compliant with NCCI guidelines, and transmits identified coding errors to the Third Party Administrator (TPA) so erroneous claim lines can be denied before payment. The service is designed for self-funded healthcare plan sponsors and TPAs, and reduces medical spend by 2%-6% on average.
• CCAR (Comprehensive Claims Audit & Reporting) CCAR is a retrospective claims payment review service for self-funded healthcare entities that combines three independent audits - Traditional Plan Audit (Benefits audit), Correct Coding Audit (Medical coding review of 100% of paid claims), and Anomaly Audit (identification of claim irregularities) - and then cross-references identified issues for synchronized validation and remediation. CCAR uses 100% of prior 24 months paid claims and delivers over 500% more savings than traditional audits by recovering overpayment refunds and identifying perpetual savings opportunities.
• Outcomes Monitoring Service (OMS) OMS is a recurring monitoring service that reruns future paid claims on a bi-annual or annual basis to ensure overspending identified in CCAR is being remediated by the administrator and to highlight new areas of concern such as disease cost trending. Designed for self-funded healthcare plan sponsors who have completed a CCAR audit and require ongoing validation that identified issues are being addressed.
• Proof of Concept Trial A free trial analysis in which LJB processes 3-6 months of already paid claims to demonstrate the value of ARMOR, expose overpayment issues ARMOR will prevent going forward, and provide a benchmark of savings and ROI ARMOR achieves on a monthly basis. Even a 2% error rate finding equates to $7.00-$10.00 per PE/PM basis. Designed for prospective self-funded healthcare clients evaluating ARMOR.

Quantifiable outcome

• 2%-6% reduction in medical spend on average
• +4 more outcomes

Named customers8 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

AI capability3 records

Feature8 records

Partnerships

Three partnerships are on record, tiered core.

• Odyssey Health Systems (OHS)coreTechnology or IntegrationOdyssey Health Systems has been a partner with LJB for several years. OHS provides medical coding expertise to support appeals and influence the design of LJB products. OHS combines technology from GE Centricity, Quatris Health, and eTactics with proven expertise. OHS is a premier medical billing, practice management, and consulting organization that optimizes revenue and ROI for healthcare providers.
• ClaimsBridge (Innovative Healthware Services, Inc.)coreTechnology or IntegrationIHS builds custom provider networks for self-insured employer groups and their servicing TPAs. ClaimsBridge Custom Provider Network services and ClaimsBridge Connects EDI transaction management services integrate with LJB's ARMOR to provide seamless implementation for TPAs and their clients. Combined services reduce cost to self-funded employers while making ARMOR seamless to the TPA.
• Trilogy Consulting GroupcoreImplementation/ SI/ Consulting PartnerTrilogy Consulting Group is LJB's on-site audit partner for CCAR execution. One of the most respected audit firms in the United States with 25 years of experience auditing self-funded entity plans under ASO agreements. Published 'The Trilogy Claims Administrative Handbook,' a 2,500-page reference used by major insurance companies, TPAs, and auditors. Corporate clients include Toyota, Briggs & Stratton, McDonalds, and Wrigley. Also provides services to Taft-Hartley Plans including Sheet Metal Workers, Pipefitters, Laborers, and Plumbers unions.

Scale indicators6 records

Recent moves6 records

Expansion highlights4 records

Others

• Datavant: Datavant focuses on health data exchange and connectivity across providers, payers, and TPAs, serving as an enabling infrastructure layer adjacent to LJB's claims-editing workflow integrations.
• Availity: Availity operates a healthcare clearinghouse and provider-payer data exchange platform used by many of the same TPAs that integrate with LJB, making it an adjacent ecosystem participant rather than a direct competitor.

Direct peers

• Cotiviti: Cotiviti is a leading healthcare payment-integrity vendor offering pre-pay and post-pay claims editing, audit, and overpayment recovery services for payers, directly competing with ARMOR and CCAR in the same self-funded and commercial payer market.
• Aspirion: Aspirion specializes in complex claims recovery and payment integrity for health systems and payers, including retrospective overpayment identification that competes with LJB's CCAR audit offering.
• Zelis: Zelis provides healthcare cost-containment and claims cost-management services including claims editing, payment integrity, and network solutions for health plans and TPAs, overlapping directly with ARMOR's pre-payment editing and CCAR's audit offerings.
• MultiPlan: MultiPlan is a cost-containment vendor for payers offering claim cost reduction, audit, and overpayment identification services that compete with LJB's CCAR retrospective audit and ARMOR-driven overpayment protection.
• Lyric (formerly ClaimsXten): Lyric, formerly ClaimsXten, provides claims-editing rules engines and code-editing software used by payers and TPAs to scrub claims pre-adjudication, which is the same core function as LJB's ARMOR product.

Broad incumbents

• Optum (Change Healthcare): Optum, including the acquired Change Healthcare business, offers a broad portfolio of claims editing, payment integrity, and analytics solutions to payers and TPAs, providing an integrated alternative to LJB's standalone ARMOR and CCAR services.
• Experian Health: Experian Health provides a broad suite of healthcare data, eligibility, claims management, and payment-integrity tools for hospitals and payers, offering bundled capabilities that overlap with LJB's claims editing and audit solutions.

Emerging players

• Codoxo: Codoxo is an AI-driven payment-integrity platform for health plans that uses machine learning to detect claim errors, fraud, and overpayments, emerging as a technology-forward competitor to ARMOR's rule-based editing.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/the-ljb-group-llc

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about The LJB Group, LLC