In the world of workers’ compensation, the relationship between Claim Administrators, Third-Party Administrators (TPAs), and clearinghouses is critical for smooth billing processes. Clearinghouses act as intermediaries, processing electronic bills (e-bills) and routing them to the appropriate claims administrator. However, when TPAs like Tristar Risk Management switch clearinghouses, it can create significant disruptions for providers—unless they’re using Simplexam.
Tristar’s Clearinghouse Change: A Case Study in Potential Disruption
Effective December 2, 2024, Tristar replaced its old clearinghouse partner with Data Dimensions. This change requires providers to update their e-billing systems to use the new Payer ID (WP500) designated by Data Dimensions. For providers not using Simplexam, this transition could mean administrative headaches, missed payments, or delayed processing due to misrouted or rejected e-bills.
The Simplexam Advantage: Clearinghouse Changes Won’t Interrupt Your Billing
Simplexam users don’t have to worry about clearinghouse changes disrupting their billing process. Here’s why:
- Direct Relationships with Multiple Clearinghouses
Simplexam maintains direct integrations with a wide range of clearinghouses, including Data Dimensions. This means we’re not tied to a single clearinghouse and Simplexam can seamlessly route your e-bills to the correct destination. - Automatic Updates for Clearinghouse Transitions
When a TPA like Tristar changes clearinghouses, Simplexam handles the transition behind the scenes. Our system is updated with the new Payer ID and routing requirements, ensuring your e-bills continue to reach the appropriate clearinghouse, and payer, without any action required on your part. - Regulatory Expertise
Simplexam is built to comply with DWC regulations and ensures that your bills are processed in alignment with California’s strict e-billing standards. Even when TPAs struggle with compliance, our technology ensures your submissions are routed and tracked properly. - Minimized Administrative Burden
Switching clearinghouses often means updating software configurations and dealing with rejected or delayed bills. With Simplexam, you can focus on providing care to injured workers while we handle the administrative complexities of clearinghouse changes.
A Reliable Solution in an Uncertain Landscape
Simplexam’s e-billing platform ensures peace of mind. Even if a TPA switches clearinghouses, your billing workflow remains uninterrupted. By leveraging our technology, you eliminate the risk of rejected claims or delayed payments caused by routing errors.
FUN FACT: The County of San Bernardino also recently switched to Data Dimensions.
