Related article: Add/Edit Account Coverage for Employers
The employer accounts and the claims pertaining to the accounts will be discovered in CAC and automatically created in ClaimWorks when an employer joins the Retro group.
Although the accounts and claims are being automatically created when the criteria is met, there are scenarios when you can add custom coverage if you so desire:
The coverage dates depend on the length of the contract with the Employer TPA (non-retro). If the contract renews, the dates of the coverage need to be manually updated to reflect the renewal.
IMPORTANT NOTE: If the employer TPA is expected to go into Retro, please make sure that the dates entered on the custom coverage will not overlap. When the employer TPA dates overlap with the time the employer is part of the Retro group, duplicate claims are created.
If the employer joins the Retro group, they weren't part of the Employer TPA, and you would like to cover some time before the Retro coverage, then you want to backdate the coverage to include the claims you are interested in.
If an employer was part of Retro, but they aren't anymore, and you still want to manage them, you can add custom coverage under the Employer TPA.
You don't need to add customer coverage if an employer is already part of the Retro group, but L&I has not yet updated the coverage in CAC. You have a 60-day grace period (for example: 07/01 - 08/31, if the plan year starts in July) when new claims will continue to get created without having to add customer coverage.