Click below to identify the criteria used in determining when Utilization Review or Telephonic Case Management are called for.

 

UR/TCM REFERRAL CRITERIA

insurance claims management by TRISTARClick below to identify the criteria used in determining when Filed Case Management are called for.

 

FCM REFERRAL CRITERIA

insurance claims management by TRISTARClick below to view the advantages of Case Management.

 

CASE MANAGEMENT ADVANTAGES

insurance claims management by TRISTAR

REQUEST FOR SERVICE

 

The first step in securing our Managed Care Services is to submit a Request for Services referral form. Download the form below.

 

DOWNLOAD FORM

FOR CURRENT CLIENTS

 

To find a provider from TMC's "mosaic"of over 651,000 providers nationwide, click below and enter your password

 

TRISTAR CA MPN

 

Entire PPO Directory

To Report Fraud:
Contact our hotline at
(323) 253-0376
or
tristarhotline@sbcglobal.net

EMAIL TRISTAR MANAGED CARE

FCM REFERRAL CRITERIA

insurance claims management by TRISTAR

Field Case Management Referral Criteria

  • Inconsistent medical findings subjective can not be supported by objective findings
  • Multiple treating physicians
  • Head trauma/Loss of consciousness
  • Spinal cord injuries
  • Second/Third degree and electrical burns
  • Robberies/Assaults
  • Toxic exposures (inhalation, “sick building syndrome”)
  • “Repeat” claimants
  • Pre-existing conditions that may interfere with or prolong recovery
  • Inpatient hospitalizations
  • Amputations
  • Home modifications
  • Investigational or experimental treatment or devices
  • EE released to full duty with no MMI in sight
  • Tasks assignments
    • Obtaining information or medical records from medical provider
    • Attend an appointment to obtain MMI
    • Attend appointment to obtain RRTW mod or regular