- Administering day-to-day operations, under direction of a Board of Trustees in close concert with Counsel, Auditor, Actuary and Investment Manager.
- Scheduling and managing quarterly Board meetings; and preparing minutes.
- Preparing appeals for Board review and notifying participants of Board decisions.
- Maintaining current Collective Bargaining Agreements and Subscriber’s Agreements.
- Corresponding with participants, Employers, Local Unions and providers, in response to service, contracting or benefit issues.
- Design, production and distribution of SPDs.
- Contracting with vendors for HMO, DMO, PPO, PBM, Stop Loss and other services.
- Managing annual Open Enrollment.
- Preparing and mailing Summary of Material Modification (SMM) plan change notices.
- Invoicing, collecting, recording employer contributions and posting eligibility.
- Liquidated Damages billing and collection.
- Filing for collections in Small Claims Court.
- Preparing Employer rate increase notices.
- Maintaining up-to-the-minute eligibility records internally and with all vendors.
- Implementation and management of Disease State Management and Wellness Programs.
- Preparing monthly Financial Statements.
- Preparing plan comparisons, reports and tools to assist with benefit design and rates.
- Stop Loss reporting and claims management.
- Retiree Drugs Subsidy (RDS) management.
- Managing active or retiree reserve accounts.
- Administration of Section 125 plans.
- Dependent eligibility audits.
- Administration of pre-funded retiree plans.
CLAIMS DEPARTMENT: LIA has a computerized claims adjudication system with the proper balance between automation and human reasoning, resulting in exemplary external audits. LIA’s clearinghouse, Emdeon, supports electronic claims submission from most PPOs. There is no restriction to the number of PPOs that can be supported by our computer system. LIA contracts with Fairhealth (previously Ingenix) for electronic UCR access. Currently 85% of claims LIA processes each month are received electronically.
MEDICARE CROSSOVER: LIA contracts with the Centers of Medicare and Medicaid (CMS) to participate in their Medicare crossover program and receives Medicare claims electronically - a process that minimizes potential fraud and expedites turn-around time.
COBRA ADMINISTRATION: LIA maintains reliable procedures for automated administration of the Consolidated Omnibus Budget Reconciliation Act (COBRA) to assure compliance with Federal regulations.
HIPAA PRIVACY / SECURITY: LIA has HIPAA Privacy and Security Officers, conducts ongoing HIPAA training and maintains HIPAA Privacy and Security Manuals with policies and procedures - for full compliance with HIPAA rules, including EDI encryption mandates.
CUSTOMER SERVICE: LIA takes great pride in the high level of customer service we provide every day to Participants, Employers, Union Locals, Trustees and Fund Staff.
COMPUTER TECHNOLOGY: LIA’s software vendor, basys, provides system flexibility that supports a limitless number of plan designs and types of eligibility rules – for easy customization and plan changes without complications or delays. In collaboration with basys, LIA is well positioned to meet deadlines for EDI 5010 and ICD-10 compliance.
