Precision Billing for Every Stage of Women's Care.
From the first confirmatory visit through delivery, and from routine wellness exams through complex gynecologic surgery, OB/GYN billing carries rules that generic medical billers consistently get wrong. ProvidaRCM's women's health billing team protects your revenue at every stage of care with specialty-trained precision.
- AAPC Certified
- No Long-Term Contracts
- HIPAA Compliant
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99%
First-Pass Claim Rate
Industry avg. is 95%
500+
Providers Nationwide
Across all 50 states
24
Avg. A/R Days
Down from 52+ for most clients
20% to 25%
Avg. Revenue Increase
Within 90 days of launch
OB/GYN Specialties We Support
Every women's health subspecialty carries distinct billing rules, global package structures, and payer requirements. Here is how ProvidaRCM improves reimbursement for each.
General Obstetrics
Routine and complicated pregnancy care
Obstetric billing centers on the global maternity package, a bundled fee covering routine antepartum care, delivery, and postpartum care. Correctly determining when to bill globally versus itemizing antepartum visits is the single most consequential billing decision in an OB practice.
59400595105942559426
General Gynecology
Wellness exams and outpatient procedures
General gynecology billing spans annual wellness exams, contraceptive management, and abnormal bleeding workups. The overlap between preventive and problem-focused visits on the same day is one of the most common sources of denial in outpatient gynecology.
993859939558300
Maternal-Fetal Medicine
High-risk pregnancy consultation and imaging
MFM specialists bill high-complexity consultative visits, detailed fetal anatomy ultrasounds, and invasive procedures like amniocentesis. Authorization for advanced fetal imaging requires documentation of the specific high-risk indication driving the referral.
768117681259000
Gynecologic Surgery
Hysterectomy, myomectomy, and ablation
Gynecologic surgical billing spans abdominal, vaginal, and laparoscopic hysterectomy, myomectomy, and endometrial ablation, each with distinct approach-based coding. Surgical approach documentation in the operative report must precisely match the CPT code billed.
581505826058571
Minimally Invasive Gynecology
Laparoscopic and robotic-assisted procedures
Minimally invasive gynecologic surgery billing requires precise distinction between diagnostic and operative laparoscopy, and correct add-on coding when multiple procedures are performed through the same laparoscopic access in one session.
585505855858661
Reproductive Endocrinology
Fertility diagnostics and treatment coordination
Fertility billing involves complex diagnostic workups and ovulation induction monitoring, many components of which fall under separate fertility-specific benefit riders requiring distinct verification from standard medical benefits.
768308925058970
Infertility Services
IVF, IUI, and treatment cycle coordination
Infertility treatment billing requires clear self-pay and insurance workflows, since many treatment components are non-covered absent a specific fertility rider, while the diagnostic workup is often covered under standard medical benefits.
589748926899213
Urogynecology
Pelvic floor and incontinence procedures
Urogynecology billing covers pelvic organ prolapse repair, urinary incontinence procedures, and urodynamic testing, each requiring documentation distinguishing covered functional impairment from non-covered cosmetic concerns.
572885179851741
Women's Preventive Care
Screening and wellness services
Preventive women's health billing covers annual wellness exams, cervical cancer screening, mammography referral coordination, and contraceptive counseling, each with distinct frequency and coverage rules under the Affordable Care Act preventive mandate.
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OB/GYN Revenue Challenges
Women's health billing carries unique complexity around global maternity packages, preventive-versus-problem visit overlap, and surgical approach-specific coding.
01
Global Maternity Package Determination
Deciding whether to bill the global OB package or itemize antepartum, delivery, and postpartum care separately is the highest-stakes decision in obstetric billing. Transfer-of-care cases billed globally generate denials or recoupment; itemizable cases billed globally leave revenue uncaptured.
02
Preventive vs. Problem-Focused Visit Overlap
Annual wellness exams frequently surface a problem requiring additional evaluation on the same visit. Correctly applying modifier 25 to bill both the preventive and problem-focused E/M requires precise documentation review on every combined visit.
03
Surgical Approach-Specific Coding
Hysterectomy and related surgery codes are structured by surgical approach: abdominal, vaginal, laparoscopic, or robotic-assisted. Operative report documentation must precisely match the code billed, and converted or hybrid approaches require careful review.
04
Ultrasound Completeness Documentation
Complete versus limited obstetric and gynecologic ultrasound codes require documentation of specific anatomic elements assessed. Billing complete when only a limited study was documented generates systematic downcoding risk on audit.
05
Frequency Limit Compliance
Payers limit routine obstetric ultrasounds per pregnancy absent specific high-risk indications. Prenatal panels, genetic screening, and monitoring ultrasounds each carry distinct frequency rules requiring per-patient tracking.
06
Global Surgery Period Management
Major gynecologic surgery carries a 90-day global period. Post-op visits for unrelated conditions, staged procedures, and complications each require specific modifiers to avoid incorrect bundling into the surgical fee.
07
Prior Authorization for High-Risk Care
MFM consultation, advanced fetal imaging, and non-standard obstetric procedures require authorization with documentation of the specific high-risk indication, not generic risk language.
08
NCCI Bundling Edits
Combined procedures such as hysterectomy with concurrent prolapse repair or sling placement are subject to extensive bundling edits. Correct modifier application determines whether legitimate additional work is separately reimbursed.
09
Coverage Determination for Fertility Services
Infertility diagnostic workup is often covered under standard medical benefits while treatment falls under separate fertility riders. Billing without verifying both benefit types independently generates systematic denial.
10
Medicare and Commercial Payer Policy Differences
Preventive service coverage, global surgery rules, and modifier requirements often differ meaningfully between Medicare, Medicaid, and commercial payers, requiring current, payer-specific knowledge on every claim.
High-Value OB/GYN Billing Insights
Understanding where women's health revenue is created, lost, and recoverable is the foundation of specialty-specific revenue cycle management.
Revenue Opportunities
Revenue Your OB/GYN Practice Is Not Capturing
Most OB/GYN practices under-capture revenue from itemizable antepartum care and add-on services performed but not fully billed.
Antepartum visits under-billed when transfer of care applies but global package is billed by default
Modifier 25 missed on same-day preventive and problem-focused visits
Detailed anatomy ultrasounds billed under standard obstetric ultrasound codes
Add-on procedures during combined laparoscopic surgery sessions left uncaptured
Preventable Denials
Denials Your Practice Should Never See
Most OB/GYN denials trace to predictable, correctable process failures such as global package misapplication or missing modifiers.
Care continuity verified before every global maternity claim
High-risk indication documentation compiled before every MFM authorization
Documentation Quality
Documentation Gaps That Drive Denials
OB/GYN denials are disproportionately driven by documentation insufficiency around surgical approach and visit count.
Surgical approach in operative report verified against CPT code before submission
Ultrasound anatomic element completeness confirmed before code selection
Every OB/GYN Denial Type. Every Fix.
Click any denial type to see why it happens, its financial impact, the prevention strategy, and how ProvidaRCM resolves it.
01
Global Maternity Denials — Care Continuity MismatchWhy It Happens
Global package billed when patient transferred care mid-pregnancy, or itemized billing used when global should have applied.
Financial Impact
Denial or recoupment on the global fee. Itemizable cases billed globally leave significant antepartum revenue uncaptured.
Prevention
Care continuity verified against the full pregnancy record before every global claim is submitted.
ProvidaRCM Solution
Transfer-of-care cases identified early and billed with itemized codes as appropriate to the actual care provided.
02
Modifier Errors — Preventive/Problem OverlapWhy It Happens
Modifier 25 missing on same-day problem-focused E/M billed alongside a preventive wellness visit.
Financial Impact
Problem-focused E/M bundled into the preventive fee, losing revenue on every combined visit of this type.
Prevention
Every same-day preventive and problem-focused encounter reviewed for modifier 25 support before submission.
ProvidaRCM Solution
Documentation review applied to every combined visit; modifier 25 applied only where separately significant work is documented.
03
Surgical Approach MismatchWhy It Happens
CPT code billed does not match the surgical approach documented in the operative report, especially for converted procedures.
Financial Impact
Claim denied or downgraded on audit, with high-value surgical claims representing significant per-case loss.
Prevention
Operative report reviewed for exact surgical approach and any conversion before code selection.
ProvidaRCM Solution
Approach-specific coding protocol applied to every gynecologic surgical claim before submission.
04
Prior Authorization Denials — MFM and High-Risk CareWhy It Happens
Auth submitted without the specific high-risk indication documented, or missing clinical justification linking imaging to a risk factor.
Financial Impact
Complete denial of consultation or imaging fee, requiring extensive appeal given clinical stakes involved.
Prevention
Specific high-risk indication compiled and documented in every MFM referral and authorization submission.
ProvidaRCM Solution
Auth packages assembled with complete indication documentation; peer-to-peer reviews coordinated for initial denials.
05
Ultrasound Coding Errors — Complete vs. LimitedWhy It Happens
Complete obstetric ultrasound billed when the report documents only limited anatomic elements assessed, or vice versa.
Financial Impact
Downcoded on audit or denied outright, affecting every study of the same type in the practice.
Prevention
Ultrasound report reviewed for anatomic element completeness against CPT criteria before code selection.
ProvidaRCM Solution
Documentation checklist applied before every claim; complete versus limited determination verified against the report.
06
Frequency Limit Denials — Ultrasound and Prenatal TestingWhy It Happens
Ultrasounds or prenatal panels billed beyond payer-specified per-pregnancy frequency limits without documented high-risk justification.
Financial Impact
Automatic denial with limited appeal options absent a documented high-risk indication for the additional study.
Prevention
Per-pregnancy ultrasound and testing frequency tracked per patient per payer with alerts before limits are reached.
ProvidaRCM Solution
Frequency calendar maintained for every OB patient; high-risk justification documented proactively.
07
Documentation Gaps — Visit Count and Global PeriodWhy It Happens
Antepartum visit count billed does not match the documented encounter history, or post-op visit billed without global period modifier support.
Financial Impact
Claim denied or downgraded to lower visit-count code, accumulating across post-surgical visit volume.
Prevention
Antepartum visit count verified against the encounter record before billing.
ProvidaRCM Solution
Visit count cross-referenced against clinical record before every itemized antepartum claim.
08
Timely Filing Denials — Global Maternity ClaimsWhy It Happens
Global claim submitted after payer's filing window, often delayed because the claim isn't finalized until after delivery.
Financial Impact
Complete, effectively permanent loss on the entire global package fee, one of the highest-value claim types in the practice.
Prevention
Filing deadline calculated from the first antepartum visit date, not the delivery date.
ProvidaRCM Solution
Global maternity filing deadlines tracked from first antepartum encounter with automated alerts.
09
ICD-10 to CPT MismatchWhy It Happens
ICD-10 codes submitted do not support the procedure billed under payer policy for the documented indication.
Financial Impact
Denial for lack of medical necessity requiring clinical appeal, generating denial backlogs on similar procedures.
Prevention
ICD-10 and CPT alignment reviewed against payer policy before every claim submission.
ProvidaRCM Solution
Current payer policies applied to every OB/GYN claim before filing.
10
NCCI Bundling Denials — Combined Surgical ProceduresWhy It Happens
Multiple procedures performed in one surgical session billed without appropriate modifier to justify separate billing.
Financial Impact
Legitimate additional work bundled and unpaid, reducing revenue on combined procedure cases.
Prevention
Current NCCI edit tables reviewed before every multi-procedure surgical claim is submitted.
ProvidaRCM Solution
Modifier 59 or 51 applied where documentation supports distinct procedure billing per NCCI guidance.
Common OB/GYN CPT Codes
Every OB/GYN CPT code billed by ProvidaRCM is reviewed against clinical documentation, global package rules, and payer-specific criteria before submission.
| CPT Code | Description | Typical Use |
|---|---|---|
| 59400 | Routine obstetric care including antepartum care, vaginal delivery, and postpartum care | Global maternity package. Applies only when the same provider or group manages care continuously throughout the pregnancy. |
| 59510 | Routine obstetric care including antepartum care, cesarean delivery, and postpartum care | Global package for cesarean delivery. Same continuity-of-care requirement as 59400. |
| 59425 | Antepartum care only; 4–6 visits | Used when global package does not apply. 59426 applies for 7 or more visits. |
| 59409 | Vaginal delivery only | Delivery-only billing when antepartum and postpartum care were managed by a different provider or practice. |
| 99385 | Initial preventive visit, new patient, age 18–39 | Annual well-woman exam. Problem-focused E/M billed with modifier 25 when separately significant. |
| 58150 | Total abdominal hysterectomy | Approach-specific code. Vaginal approach uses 58260 series; laparoscopic uses 58571 series. |
| 58571 | Laparoscopic hysterectomy with removal of tube(s) and/or ovary(s), uterus 250g or less | Weight-tier specific. Documentation of uterine weight and removal method required. |
| 76805 | Obstetric ultrasound, complete, first trimester or greater | Requires documentation of all required anatomic survey elements. 76815 applies for limited studies. |
| 76811 | Obstetric ultrasound, detailed fetal anatomic examination | MFM-level detailed anatomy scan, distinct from standard complete ultrasound. |
| 59000 | Amniocentesis, diagnostic | Requires documentation of indication and imaging guidance when used. |
| 58300 | Insertion of intrauterine device | Insertion procedure fee. Device billed separately under applicable HCPCS code. |
| 57288 | Sling operation for stress incontinence | Requires documentation of functional impairment and failed conservative treatment for most payers. |
| 58558 | Hysteroscopy with biopsy or polypectomy | Diagnostic and operative hysteroscopy combined. Distinct code exists for diagnostic-only hysteroscopy. |
Common OB/GYN ICD-10 Codes
Diagnosis specificity determines whether OB/GYN procedures meet payer medical necessity criteria.
| ICD-10 | Diagnosis | Typical Use |
|---|---|---|
| Z34.90 | Encounter for supervision of normal pregnancy, unspecified trimester | Primary routine antepartum diagnosis. Trimester and week-specific codes preferred when documented. |
| O09.90 | Supervision of high-risk pregnancy, unspecified trimester | Primary high-risk indicator supporting MFM referral and additional ultrasound frequency. |
| N92.0 | Excessive and frequent menstruation with regular cycle | Common abnormal bleeding diagnosis supporting biopsy, ablation, or hysterectomy medical necessity. |
| N80.9 | Endometriosis, unspecified | Supports surgical intervention billing, including laparoscopic excision. |
| N81.10 | Cystocele, unspecified | Supports urogynecologic surgical repair when paired with functional impairment documentation. |
| N39.3 | Stress incontinence (female) | Primary indication for sling procedures. Conservative treatment failure typically required. |
| O80 | Encounter for full-term uncomplicated delivery | Used for the delivery encounter when no complications are present. |
| Z30.430 | Encounter for insertion of intrauterine contraceptive device | Supports IUD insertion billing. Distinct codes exist for removal and reinsertion. |
| N97.9 | Female infertility, unspecified | Primary infertility workup diagnosis. More specific codes preferred when documented. |
| C56.9 | Malignant neoplasm of unspecified ovary | Supports gynecologic oncology surgical staging and treatment billing. |
Common OB/GYN Billing Modifiers
Modifier accuracy on OB/GYN claims determines whether preventive and problem overlap visits, surgical global periods, and bilateral procedures are correctly reimbursed.
| Modifier | Description | Typical Usage | Denial Risk |
|---|---|---|---|
| 25 | Significant, Separately Identifiable E/M | Applied when a problem-focused E/M is billed alongside a preventive exam or minor procedure and separately documented as significant. | Very High |
| 50 | Bilateral Procedure | Applied when a procedure is performed bilaterally in the same session, such as bilateral salpingo-oophorectomy. | High |
| 51 | Multiple Procedures | Applied to secondary procedures when multiple distinct surgeries are performed in the same session. | High |
| 52 | Reduced Services | Applied when a procedure is partially reduced or discontinued relative to the full code description. | Low |
| 59 | Distinct Procedural Service | Overrides NCCI bundling when procedures are genuinely distinct, such as different anatomical sites or separate sessions. | Moderate |
| 76 | Repeat Procedure by Same Physician | Applied when the same procedure is legitimately repeated same-day by the same physician. | Low |
| RT | Right Side | Site-specific modifier for right-sided procedures, required by Medicare for laterality-dependent surgery. | Moderate |
| LT | Left Side | Site-specific modifier for left-sided procedures, required by Medicare for laterality-dependent surgery. | Moderate |
Prior Authorization Challenges
High-risk obstetric care, advanced imaging, and major gynecologic surgery each carry distinct authorization requirements.
Surgical Authorization
Hysterectomy
Requires documentation of medical necessity distinguishing covered indication from elective concern, plus imaging or pathology support.
Medical necessity documentation compiled before every submission
Surgical Authorization
Laparoscopic Procedures
Auth may be denied when the specific laparoscopic technique and clinical indication are not clearly documented in the referral.
Technique-specific documentation matched to payer criteria
Coverage Verification
Fertility Treatments
IVF and IUI often require verification of a separate fertility benefit rider distinct from standard medical coverage.
Standard and fertility benefits verified independently before treatment
High-Risk Care
High-Risk Pregnancy Services
Requires the specific high-risk indication driving the referral; generic risk statements are insufficient for most payers.
Specific risk factor documentation compiled for every referral
Imaging Authorization
Advanced Imaging
Detailed fetal anatomy ultrasound requires distinct clinical justification separate from routine obstetric imaging.
Screening result or risk factor linked explicitly to the auth request
Diagnostic Authorization
Genetic Testing
Prenatal genetic screening requires documentation of maternal age, family history, or abnormal screening supporting the test requested.
Clinical indication compiled and matched to payer coverage criteria
Where OB/GYN Revenue Disappears
These leakage patterns compound across a women's health practice's full patient volume, often without appearing as visible denials.
Global Package Misapplication
CriticalItemizable transfer-of-care cases billed globally leave significant antepartum revenue uncaptured. Global cases billed itemized generate denial or recoupment risk.
Missing Modifier 25
HighProblem-focused visits bundled into preventive exams when modifier 25 is missing, systematically losing revenue across combined visit types.
Ultrasound Coding Mismatch
HighDetailed anatomy scans billed under standard obstetric ultrasound codes, or complete studies billed when only limited elements were documented.
Surgical Approach Errors
HighHysterectomy and related procedures billed under the wrong approach-specific code family when conversions are not carefully reviewed.
Underpayments Not Audited
ModerateGlobal maternity and multi-procedure surgical payments accepted below contracted rates without ERA audit.
Unworked Denials
ModerateGlobal package and surgical denials left unappealed because in-house teams lack specialty expertise for care-continuity appeals.
Complete OB/GYN Billing Services
Every service in the women's health revenue cycle, delivered by billers trained specifically in global maternity packages and gynecologic surgery.
Insurance Verification
Coverage confirmed before every visit, including maternity benefit and fertility rider verification.
Benefits Investigation
Maternity, surgical, and fertility-specific benefit investigation per payer and plan.
Prior Authorization
Auth obtained with complete clinical indication documentation for surgery, imaging, and consultation.
Medical Coding
Global versus itemized determination, approach-specific surgical coding, and ultrasound completeness verification.
Claims Submission
Clean electronic submission within 48–72 hours with clearinghouse tracking and rejection correction.
Denial Management
Every denial appealed with care continuity and clinical documentation support.
A/R Follow-Up
Active weekly follow-up on all open claims with global and surgical claims prioritized.
Payment Posting
ERA audited against contracted rates with global package payment verification.
Reporting & Analytics
Monthly KPIs including first-pass rate, denial trends, and global package accuracy reporting.
OB/GYN Provider Credentialing
Every new OB/GYN physician or midwife requires credentialing before claims can be submitted. ProvidaRCM manages the complete process nationwide.
Medicare Enrollment (PECOS)
PECOS enrollment for OB/GYN physicians, MFM specialists, and certified nurse midwives.
Medicaid — All 50 States
State Medicaid and managed Medicaid credentialing with women's health coverage policy tracking.
Commercial Payer Enrollment
Credentialing with major commercial payers and regional health plans with active follow-up.
CAQH Management
CAQH ProView profile creation and ongoing maintenance kept current for enrollment.
Hospital Delivery Privileges
Hospital affiliation and delivery privilege credentialing for OB physicians and midwives.
Women's Health Networks
Enrollment in specialty women's health provider networks and referral panels.
Why Generic Billing Companies Struggle With OB/GYN
Women's health billing carries unique complexity around global packages and surgical approach coding that generalist billers routinely mishandle.
✗ Generic Medical Billers
✗ Do not verify care continuity before billing the global maternity package
✗ Miss modifier 25 on same-day preventive and problem-focused visits
✗ Cannot verify surgical approach against operative documentation
✗ Do not track per-pregnancy ultrasound frequency limits
✗ Confuse standard medical benefits with separate fertility riders
✗ Calculate global maternity filing deadlines from delivery date rather than first visit
✓ ProvidaRCM OB/GYN Team
✓ Care continuity verified against the full pregnancy record before every global claim
✓ Modifier 25 validated on every same-day preventive and problem-focused encounter
✓ Operative reports reviewed for exact surgical approach before code selection
✓ Per-pregnancy ultrasound frequency tracked with proactive alerts
✓ Standard medical and fertility-specific benefits verified independently
✓ Global maternity filing deadlines calculated from first antepartum visit date
OB/GYN Revenue Cycle Process
A structured, women's health-specific workflow from scheduling through revenue optimization.
1
Eligibility Verification
Coverage and maternity or surgical benefits confirmed before every visit
2
Benefits Investigation
Maternity, surgical, and fertility rider coverage identified per payer
3
Prior Authorization
Auth obtained with clinical indication documentation before treatment begins
4
OB/GYN Coding
Global determination, surgical approach verification, and ultrasound review applied
5
Claims Submission
Clean filing within 48–72 hours with clearinghouse tracking
6
Payment Posting
ERA audited against contracted rates before acceptance
7
Denial Management
Every denial appealed with clinical documentation and root-cause correction
8
Reporting & Optimization
Monthly OB/GYN KPIs and revenue optimization roadmap delivered
In-House Billing vs. ProvidaRCM
The true cost of in-house OB/GYN billing includes salary, training, and revenue lost to expertise gaps on global maternity and surgical claims.
| Category | In-House OB/GYN Billing | ProvidaRCM |
|---|---|---|
| Total Cost | Salary, benefits, training, and software as fixed cost regardless of volume | 2.49% of net collections, all-inclusive, scales with revenue |
| OB/GYN Expertise | General billers without global maternity or surgical approach training | OB/GYN-specific billers trained in maternity packages and gynecologic surgery |
| Global Package Accuracy | Care continuity not verified, causing systematic billing errors | Care continuity verified against pregnancy record before every claim |
| Surgical Coding | Approach not verified against operative report, causing code mismatches | Every surgical claim verified against documented approach before filing |
| Modifier Accuracy | Modifier 25 applied inconsistently, losing overlap visit revenue | Modifier 25 validated on every combined visit before submission |
| Denial Management | Global package denials often left unappealed | Every denial appealed with care continuity and clinical documentation |
| Scalability | Adding providers requires new hiring and proportional overhead | Scales immediately as provider count and volume grow |
Free Revenue Audit
Find Out What Your OB/GYN Practice Is Actually Owed
ProvidaRCM offers a complimentary billing audit for OB/GYN practices. We review your last 90 days of claims, identify revenue gaps on maternity and surgical billing, and deliver a concrete recovery plan at no cost.
Revenue Review
Coding Assessment
Denial Analysis
A/R Review
Recovery Opportunities
OB/GYN Billing Case Studies
Three examples of how specialty OB/GYN billing expertise translates to measurable revenue improvement, without fabricated numbers.
Case Study 01
Independent OB/GYN Practice
Challenge
A two-physician practice was consistently billing the global maternity package by default, even for patients who transferred care mid-pregnancy, resulting in denials and recoupment demands.
Solution
ProvidaRCM implemented a care continuity verification protocol reviewing the full pregnancy record before every global claim, with transfer-of-care cases itemized correctly instead.
Outcome
Global package denials and recoupment demands were eliminated, and transfer-of-care cases began capturing appropriate itemized antepartum revenue.
Case Study 02
Multi-Provider Gynecologic Surgery Group
Challenge
A surgery group was experiencing denials when laparoscopic hysterectomy procedures were converted to open approach mid-surgery, with the billing team continuing to bill the originally scheduled code.
Solution
ProvidaRCM implemented mandatory operative report review before every hysterectomy claim, verifying the documented approach including any intraoperative conversion.
Outcome
Approach-mismatch denials were eliminated, and converted procedures were correctly billed under the code reflecting the surgery actually performed.
Case Study 03
Maternal-Fetal Medicine Practice
Challenge
An MFM practice was experiencing systematic denials on detailed fetal anatomy ultrasounds because claims were submitted under the standard obstetric ultrasound code.
Solution
ProvidaRCM implemented an ultrasound report review protocol verifying anatomic survey element completeness before code selection.
Outcome
Detailed anatomy ultrasound reimbursement improved through correct code selection, reflecting accurate billing of studies already performed.
OB/GYN Billing Across All 50 States
ProvidaRCM provides OB/GYN billing for practices, MFM groups, and women's health networks nationwide with current maternity policy knowledge.
50
States Covered
Active OB/GYN billing with current maternity policy
200+
Payer Relationships
Medicare, Medicaid, and commercial payers
Medicaid
Deep Expertise
State-specific maternity coverage knowledge
Fertility
Rider Verification
Separate benefit tracking per payer per plan
Questions Answered
OB/GYN Billing FAQs
Direct answers to the questions OB/GYN practices ask most about specialty women's health revenue cycle management.
01Do you bill the global maternity package correctly for transfer-of-care patients?
Yes. We review the full pregnancy record for every patient before submitting a global claim, verifying that the same provider or group managed care continuously. When a patient transferred care mid-pregnancy, we bill antepartum, delivery, and postpartum care itemized instead of defaulting to global billing.
02Can you manage gynecologic surgical billing, including approach-specific coding?
Yes. We review every operative report to verify the exact surgical approach before selecting the CPT code, including cases where a procedure was converted intraoperatively.
03Do you handle obstetric ultrasound billing, including detailed anatomy scans?
Yes. We review every ultrasound report to determine whether documentation supports a complete or limited study, and track per-pregnancy frequency limits per patient per payer.
04Can you reduce OB/GYN claim denials?
Yes. Most OB/GYN denials trace to correctable process failures such as global package misapplication or missing modifier 25. We address each with documented pre-submission processes.
05Do you support maternal-fetal medicine practices?
Yes. We handle MFM-specific billing including detailed fetal anatomy ultrasounds, amniocentesis, and authorization management requiring specific high-risk indication documentation.
06Do you support midwifery practices and collaborative care arrangements?
Yes. We manage scope-of-practice billing for certified nurse midwives, including correct provider attribution when a physician assumes care during delivery.
07Do you assist with credentialing?
Yes. We manage complete credentialing including Medicare PECOS enrollment, state Medicaid, commercial payer credentialing, CAQH management, and hospital delivery privileges.
08Do you manage prior authorizations for fertility and reproductive services?
Yes. We verify both standard medical benefits and separate fertility-specific riders independently before treatment begins to route billing correctly.
09How long does onboarding take?
Most OB/GYN practices are fully onboarded and processing claims within 3 to 5 business days, including EHR integration and care continuity tracking setup.
10How is pricing structured?
ProvidaRCM charges 2.49% of net collections, all-inclusive with no setup fees and no additional charges for authorization management or denial appeals.