Tristar Risk Management, a Third-Party Administrator (TPA) for workers’ comp claims, has changed the clearinghouse it uses to accept and respond to providers’ electronic bills (e-bills) for treating injured workers.

Effective December 2, 2024, providers should deliver e-bills to Tristar through Data Dimensions, which replaces Jopari as Tristar’s designated clearinghouse vendor.

daisyBill providers, rest easy: As always, our billing technology is updated with this change, and we will route your Tristar e-bills directly to Data Dimensions with Tristar’s new Payer ID.

Tristar is routinely non-compliant with various laws and regulations governing payment through Electronic Data Interchange (EDI), including being without equal in its failure to respond to e-bills with electronic Explanations of Review (e-EORs) as required in California.

While Tristar is legally responsible for its EDI compliance regardless of the clearinghouse involved (and there is no evidence that Jopari’s performance is at the root of Tristar’s failures), perhaps this clearinghouse switch may signal efforts at improved compliance.

Tristar Clearinghouse Switch Effective December 2, 2024

Previously, Tristar used Jopari as its designated clearinghouse. As of December 2, providers should submit e-bills for Tristar to Data Dimensions with Payer ID WP500.

Other than TPA CorVel and the federal Department of Labor, all claims administrators lack the technology and expertise to accept providers’ e-bills and remit e-EORs. Accordingly, claims administrators hire clearinghouse vendors to do the technical heavy lifting on their behalf.

For providers, successful workers’ comp e-billing depends on submitting e-bills to the claims administrator’s designated clearinghouse with the correct Payer ID assigned by the clearinghouse to the claims administrator.

EDI Compliance: Tristar Does Not Seem To Care

The switch to Data Dimensions may or may not result in better compliance by Tristar.

daisyNews has no reason to believe that Tristar’s failures resulted from Jopari's (Tristar’s previous clearinghouse) poor performance. However, blame is also moot because Tristar is responsible for its compliance, regardless of any clearinghouse vendor.

As the California Division of Workers’ Compensation Electronic Medical Billing and Payment Companion Guide states (emphasis ours):

“Billing agents, electronic billing agents, third party administrators, bill review companies, software vendors, data collection agents, and clearinghouses are examples of companies that may have a role in electronic billing. Entities or persons using agents are responsible for the acts or omissions of those agents executed in the performance of services for the entity or person.”

Over the years, Tristar has violated California laws and regulations numerous times, prompting daisyBill to submit formal Audit Complaints reporting 46,002 violations which include:

• Failure to accept e-bills from providers
• Untimely payment
• Failure to timely respond to Second Review appeals

True to form, the CA DWC has taken no action of which we are aware to address Tristar’s violations. For its part, Tristar has only made irrelevant excuses for its behavior while continuing to flout the rules.

Historically, Data Dimensions has been excellent at communicating with providers and proactively addressing e-billing issues. Will the partnership with Data Dimensions begin a new era for Tristar, in which the TPA respects the rights (and time and resources) of providers who treat injured workers?

We hope so. If not, you’ll surely read about it here on daisyNews.

Nationwide, daisyBill increases revenue and decreases hassle for providers who treat injured workers. Get a free demonstration below.

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