Keywords: TOS, Time of Service, Medicaid, employer plan, appointment type, final debond, TBD, claim queue, contract, periodic claim
Summary
This article covers how to set up and use the Time of Service Medicaid feature in Cloud 9 contracts. It walks through enabling TOS, configuring the employer plan and appointment types, how TOS contracts work, and what to expect when appointments are completed.
Overview
Some Medicaid plans require that a claim can only be submitted at the time the patient actually comes in for their appointment. Cloud 9 now supports this natively, covering the full contract lifecycle from setup through claim submission. Practices serving Medicaid and Medicaid TOS patients can manage the entire workflow in Cloud 9 without manual workarounds and can report on this population accurately.
Enabling TOS/Medicaid Functionality
Before setting up TOS, the feature must be enabled in Cloud 9. To do this you will need the permission to access Practice Information.
Navigate to Edit > Practice Information > Options tab. At the very bottom of the page, check the option that reads Enable TOS/Medicaid and save the changes. Once this is enabled you can proceed with the setup steps below.
Setup: Three Things that must be Configured
All three of these must be in place before TOS works correctly. If any one of them is missing or incorrect, claims will not post as expected.
1. Employer Plan
You will need the Employer Plans and Edit Library Items permissions to complete this step.
Navigate to Edit > Setup > Employers. Open an existing employer or create a new one. Under the employer, click the blue + to add or choose Edit to edit an employer plan. Fill in the plan name, billing center if applicable, and group number as normal.
There are two new checkboxes on the employer plan:
- Medicaid: Check this to flag the plan as a Medicaid plan. This enables Medicaid reporting filters. Checking this alone does not activate TOS automation.
-
Time of Service Required: Check this to activate TOS. This must be selected along with the Medicaid option for the Time of Service feature to work correctly.
Save the changes. Once these are set, all new contracts created under this employer plan will be TOS contracts.
Important: Existing contracts are not updated retroactively and cannot be converted to TOS after the fact. Additionally, once a contract is created as a TOS/Medicaid Contract, it cannot be converted. It would need to be written off entirely and a new contract created if it was made in error.
Note: When adding Insurance to a patient chart, a user must ensure the Employer Plan with Medicaid and Time of Service is selected.
2. Appointment Types
Navigate to Edit > Setup > Appointment Types. You will need to flag every appointment type that should generate a TOS claim. Select the appointment type and click Edit. In the upper right there is a field called Medicaid Claim/Charge. The dropdown has two options:
-
TOS Periodic Claim/Charge: Used for standard recurring appointments. Every time one of these appointments is completed, Cloud 9 automatically posts the claim and ledger entry for that date of service as long as funds remain on the contract.
-
Medicaid/TOS Final Debond Claim/Charge: Used for the final debond appointment only. The reserved final debond amount only posts when this specific appointment type is completed. If no final debond appointment is ever completed, that claim cannot be charged.
You can use existing appointment types or create new ones specifically for TOS. You can flag as many appointment types as needed under either option. It is important to make sure the Final Debond Appointment is selected and then scheduled as the last appointment for a TOS/Medicaid Contract.
3. Contract
Once the employer plan and appointment types are configured, any new contract or financial arrangement created under a TOS employer plan will automatically be a TOS contract. Before starting the contract, make sure the Final Debond Amount is entered.
TOS contracts look a little different from standard contracts:
- A Final Debond Amount field appears below the down payment field. This field is only visible on TOS contracts and sets what the final debond claim amount will be at the final debond appointment.
- All insurance charge dates will display as TBD until the appointment is completed. This is expected and not an error.
Important: Once a contract is created as a TOS contract it cannot be changed to a non-TOS contract. This designation is permanent at contract creation. Make sure the employer plan and appointment types are set up correctly before creating the contract.
How it Works Once Setup
Once everything is configured, the workflow is fully automatic. Staff complete appointments as normal and Cloud 9 handles the rest.
Periodic appointments:
When a patient is checked out from a TOS Periodic Claim/Charge appointment, Cloud 9 checks whether funds remain on the contract. If yes, it automatically posts the claim, replaces the TBD date with the actual service date, and posts the ledger charge. The claim will appear in the claim queue under New and is ready to be submitted. If no funds remain, nothing is created. This is by design.
Final debond appointments:
When the final debond appointment is completed, Cloud 9 automatically posts the final debond claim and ledger charge. This can only happen at the final debond appointment, never before.
When funds are exhausted:
Once all periodic funds are used up, Cloud 9 stops generating claims and ledger charges for periodic appointments. The only remaining claim that can post is the final debond at the final debond appointment.
Contract Adjustments
Financial adjustments can be made on and off TOS contracts. Rolling charges are automatically applied by Cloud 9 to keep the contract balanced after any adjustment is made.
Report Filtering
An Employer Plan Type filter is available on the following reports to help you track and report on your Medicaid and TOS contracts:
- Contract Starts by Date Range
- Contracts by Start Date
- Case Starts by Start Date
- Case Starts (A) by Start Date
- Case Starts (B) by Start Date
- Completed Contracts by Date Range
Filter options: None, Medicaid, or Medicaid: Time of Service Required.
As always, if you have any further questions please do not hesitate to reach out to Cloud 9 Support by emailing us at cloud9support@planetdds.com, or chatting us online using the chat bubble on the lower right at https://cloud9support.planetdds.com/hc/en-us, or giving us a call during our business hours of 8:00 AM EST to 8:00 PM EST at the 1.800.394.6050 option 2.