CLIENT SUCCESS CASE STUDY: One Platform, Many States: Onboarding a Multi-State Long-Term Care Provider onto TKSoftware’s Clearinghouse Platform
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Specialties |
States Served |
SNF Partners |
Go-Live |
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4 |
Multi-State |
Large Network |
On Schedule |
About the Client
The client is a well-established national organization providing onsite ancillary medical services for seniors living in skilled nursing facilities (SNFs). Operating across a large number of states for more than two decades, the organization has built an extensive provider network serving residents across hundreds of facilities. Their model centers on bringing specialty care directly to patients where they live, removing the need for off-site transport for elderly and mobility-limited residents.
The client delivers care across four clinical disciplines:
- Dental Care — Preventive and restorative services, including exams, cleanings, fillings, extractions, and denture fitting
- Vision Care — Annual exams, eyeglasses, and monitoring and treatment of eye diseases
- Hearing Care — Diagnostic exams, hearing testing, wax removal, and hearing aid fitting
- Podiatry Care — Nail care, infection prevention, diabetic foot care, and treatment of common foot conditions
Clinical teams travel to each facility fully equipped, and providers are trained to care for memory-care residents and those with significant mobility limitations. The organization has a strong patient satisfaction record and has grown steadily in recent years through both organic expansion and the acquisition of regional ancillary service providers. This growth, while positive, meaningfully increased the complexity of its billing and revenue cycle operations — ultimately driving the decision to transition to TKSoftware as its clearinghouse.
The Challenge
Bringing this client onto the TKSoftware platform involved navigating four challenges that overlapped during the same implementation window:
Challenge 1 — Multi-State Enrollment for Claims & Remittances Operating across a large number of states, the client needed enrollment coordinated across a substantial number of payer-state combinations — spanning Medicare, Medicaid, and commercial payers, each with their own EDI requirements. Each payer relationship required independent enrollment, testing, and activation for both claims submission and electronic remittance advice (ERA/835) before production claims could flow.
Challenge 2 — Existing Payer-Specific Edit Programming The client had an established set of payer-specific claim edits from their prior clearinghouse. Across four specialties — each with its own coding and adjudication requirements — this inventory of custom edits was considerable. Replicating these edits accurately in TKSoftware’s environment was important to maintaining consistent claim performance during the transition.
Challenge 3 — New Payer-Specific Edit Programming The client’s expansion into new states and payer relationships — including some inherited through recent acquisitions — also introduced the need for new custom edits that had not previously existed in their clearinghouse workflow. These required development from payer specifications and validation before go-live.
Challenge 4 — Concurrent Billing Platform Migration During the TKSoftware onboarding, the client was also transitioning to a new practice management and billing platform. The two implementations running in parallel added complexity around data mapping, file format validation, and go-live timing — requiring coordination across the client’s billing team, the new platform’s vendor, and TKSoftware.
The TKSoftware Approach
Dedicated Implementation Team TKSoftware assigned a dedicated implementation team familiar with multi-state long-term care and ancillary services billing. A single project manager served as the client’s main point of contact throughout, with regular check-ins to keep the client’s billing and revenue cycle teams informed as the implementation progressed.
Multi-State Payer Enrollment Management TKSoftware’s enrollment team worked through the client’s payer inventory state by state and specialty by specialty. For each payer-state combination, the team handled trading partner enrollment, configuration against payer EDI companion guides, ERA/835 routing, and pre-production testing. The client had access to ongoing status updates throughout the process. Claims were not submitted to any payer until enrollment was confirmed and testing was complete.
Custom Edit Programming — Legacy & New TKSoftware’s technical team worked with the client’s billing staff to document existing payer-specific edits from the prior clearinghouse, then rebuilt and validated them in TKSoftware’s rules engine using historical claim data for reference. New edits required by payers — including some tied to recently acquired regional operations — were developed alongside the migration work. Before go-live, edits were tested against representative claims for each specialty and reviewed with the client’s billing team.
Coordination with the Billing Platform Migration To help manage the risk of two simultaneous transitions, TKSoftware worked closely with the client’s billing team and the new platform’s vendor throughout the implementation. This included aligning on data field mapping between legacy and new systems, validating 837 file output from the new platform, and using a phased go-live approach so that a subset of payers could be activated and confirmed before the full cutover. A brief parallel-run period allowed both environments to be compared before the legacy setup was retired.
Outcomes at a Glance
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Challenge |
TKSoftware Approach |
Result |
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Multi-State Enrollment |
Worked through all payer-state combinations by specialty, with testing completed before any production submission |
Enrollments in place across all required payers prior to go-live. No interruption in revenue. |
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Legacy Edit Migration |
Documented, rebuilt, and validated existing edits against historical claims for all four specialties |
Clean claim performance maintained through the transition |
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New Edit Development |
Developed new payer-specific edits in parallel with migration work, with client review before activation |
New edits live on schedule. Acquired provider workflows integrated without disruption |
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Dual-Track Implementation |
Coordinated with billing platform vendor throughout; used phased go-live and parallel-run period |
Transition completed without lost claims |
Why This Implementation Stood Out
This client serves elderly residents of skilled nursing facilities — a population that depends on consistent access to dental, vision, hearing, and podiatry care as part of their ongoing health management. For an organization operating at this scale, a disrupted clearinghouse transition carries real consequences for both cash flow and care continuity.
The added complexity of a simultaneous billing platform migration, combined with the need to absorb recently acquired provider operations into a unified workflow, meant that careful coordination across multiple workstreams was essential. TKSoftware’s implementation team worked closely with the client throughout, keeping the process on track and ensuring that enrollment, custom edits, and file validation were all in place before any claims moved to production.
The result was a transition that stayed on schedule and maintained clean claim performance from the outset.
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” As a national healthcare provider, we are beholden to the unique and varied coding and billing requirements of a host of federal, regional and state level payers. Often times these requirements do not fit neatly into the pre-canned workflows and coding scrubs available within our EMR. We were struggling with our legacy clearinghouse partner who was unable to assist with the unique demands of our payers leading to a series of manual workarounds that were both inefficient and error prone.
When we presented our challenges to TKSoftware, they offered to collaborate with our team and develop custom tools on their platform to automate several manual processes. TKSoftware established trust through the discovery process and gave us confidence they would deliver on their promises.
Fast forward to today and TKSoftware has exceeded expectation on all fronts. The onboarding process went smoothly from start to finish. Our users find the platform to be highly intuitive and the training provided was comprehensive. Not only has the manual workload been reduced for our team, we have better visibility and means to work denials and tackle billing challenges as they arise.
Most importantly, TK has established itself as trusted partner and we know that they will continue to support us as our business grows and the billing landscape becomes more complicated over time. the TKSoftware team have been a pleasure to work with from the moment we were introduced.” – Chief Strategy Officer, National Long-Term Care Ancillary Services Provider
TKSoftware provides us with improved workflow efficiency: With the customized configuration in place, many manual processes previously required to correct and submit claims have been eliminated for our billing team. Examples include hospice modifier application, deductible holds, state-specific secondary claim requirements, and the addition of referring providers on designated claims.“ – Senior Billing Manager, National Long-Term Care Ancillary Services Provider
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About TKSoftware
TKSoftware provides RCM services, including clearinghouse and integrated billing software, to healthcare providers, billing companies, and management service organizations across the United States. TKSoftware supports multi-specialty billing environments and has experience working with ancillary service providers — including dental, vision, hearing, and podiatry organizations — operating across multi-state payer networks.
To learn more, contact us at matt@tksoftwareinc.com or visit tksoftwareinc.com.