Keywords: TOS , Medicaid , Insurance, Time of Service
What's New
Cloud9 now provides full support for Medicaid and Medicaid – Time of Service (TOS) Required employer plans, covering the complete contract lifecycle from setup through claim submission. This includes designating employer plans and appointment types as Medicaid/TOS, handling contracts with undetermined (“TBD”) service dates, processing periodic and final debond appointment completions, making on- and off-contract adjustments, and filtering contract reports by employer plan type.
Why This Matters
Practices serving Medicaid and Medicaid-TOS patients can now manage the entire contract-to-claim workflow for these plans natively in Cloud9, without manual workarounds, and can report on this population accurately.
What to Expect / How It Works
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Employer Plan Designation: “Medicaid” and “Time of Service Required” checkboxes are available on Employer Plans. “Time of Service Required” can only be selected if “Medicaid” is also selected. Once these options are set, all new contracts created for that employer plan will be created as Medicaid/TOS contracts accordingly; existing contracts already created under that employer plan are not updated retroactively.
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Appointment Type Designation: Appointment Types can be flagged as “TOS Periodic Claim/Charge” or “Medicaid/TOS Final Debond Claim/Charge” so the system knows which workflow to trigger on completion.
- Contract Charge Dates: Insurance charge rows on TOS contract payment plans display “TBD” instead of a date until the service date is known, and ledger entries are not created for these charges until that date is resolved. TOS payment plans are labeled accordingly in the contract header.
- Final Debond Setup: A Final Debond Amount field and CDT code lookup are available on TOS/Medicaid payment plans, generating a Final Debond charge line and claim (date TBD) when the contract is started.
- Periodic Appointment Completion: Completing a “TOS Periodic Claim/Charge” appointment updates the claim and ledger entry with the service date, if funds remain on the contract.
- Final Debond Appointment Completion: Completing a “Medicaid/TOS Final Debond Claim/Charge” appointment updates the claim and final debond ledger transaction with the service date.
- Contract Adjustments: Users can make financial adjustments on and off TOS contracts, with rolling charges automatically applied to keep the contract balanced.
- Report Filtering: An “Employer Plan Type” filter (None / Medicaid / Medicaid – Time of Service Required) is available on Contract Starts by Date Range and Contracts by Start Date reports, as well as Case Starts by Start Date, Case Starts (A) by Start Date, Case Starts (B) by Start Date, and Completed Contracts By Date Range.
Important: Once a contract is created as a Time of Service contract, it cannot later be changed to a non-TOS contract. This designation is permanent at contract creation.
Action Required: Practices wanting to use Medicaid/TOS functionality should contact PlanetDDS to have it enabled. Once enabled, verify the employer plan and appointment type designations are set correctly before creating contracts, given that the TOS designation cannot be reversed once a contract is created.
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.