OB/GYN Billing Services: Maternity & GYN Claims From 5.0%

Who our OB/GYN billing service is for

Our OB/GYN billing service is built for independent obstetric and gynecology practices, whether one obstetrician or a group of 6–15 clinicians. Our scope is the professional claims for prenatal visits, hospital deliveries, postpartum care, in-office obstetric ultrasounds and fetal testing, and office gynecology procedures such as colposcopy, hysteroscopy and IUD placement.

Hand your billing to us when:

• patients transfer in or out mid-pregnancy, and nobody is sure which part of the maternity care your practice can still bill;
• antepartum visits sit unbilled while the team waits for deliveries, and filing deadlines pass;
• patients due in 2027 are already on the schedule, and nobody has planned for the new maternity codes;
• the biller who kept the prenatal visit counts has left.

What we take over from your OB/GYN team, and what your practice keeps

We run your professional OB/GYN claims from the signed prenatal or procedure note to the posted payment, as the figure shows. Every code passes our documentation-based coding review. We check every code against your clinician's documentation and never change a code without the clinician's sign-off. Coverage is checked for new patients and whenever a patient's coverage changes, through our insurance eligibility checks.

Read the workflow as text

1. Build pregnancy ledger — Due dates, routine visit counts and transfers tracked for every patient. Owner: Our billing team.
2. Sign each note — Prenatal and procedure notes signed, with decision making or time recorded. Owner: Your clinicians.
3. Check codes by phase — Codes checked against the note; each phase billed to the practice that gave it. Owner: Our coding team.
4. Submit each claim — Claims out within 1 business day of complete charge data. Owner: Our billing team.
5. Work denials, post payments — Denials worked within 2 business days; remittances posted within 2 business days. Owner: Our billing team.
6. Monthly KPI report — Definitions included, plus open pregnancies and unbilled antepartum visits. Owner: Sent to you.

Where maternity and gynecology claims leak money, and what we do about it

OB/GYN revenue leaks where a pregnancy stops being one practice's work: a transfer at 30 weeks, a covering group's delivery, a visit count that closes at year end.

Maternity care split between practices

• A global code goes out after care was split. We maintain a pregnancy ledger showing which practice provided prenatal, delivery and postpartum care, then bill the phases your group actually supplied.
• Antepartum claims wait on a visit count and miss the filing limit. We close the prenatal visit count at transfer or the end of your care and track the resulting claim against the relevant plan's deadline. The payer filing deadline guide explains why product-specific dates matter.

Patients due on or after January 1, 2027

• The global maternity codes end. We review the maternity code transition with your payer mix before affected claims go out, keeping care dates and the plan's implementation instructions in the pregnancy ledger.
• Prenatal notes written for a package, and plans that switch on their own dates. We check the prenatal note templates and payer transition plan with your team so separately documented services remain identifiable through the change.

Ultrasounds, office gynecology and LARC at delivery

• Ultrasounds and office procedures billed with the wrong component or setting. We match ultrasound ownership, interpretation and procedure setting to the professional claim; your clinicians approve any coding query.
• Contraception at delivery left off the claim. We check the documented device and insertion against the payer's maternity billing instructions so a separately payable service is not lost inside the episode.

What our OB/GYN billing costs

OB/GYN practices pay our specialist rate (Specialist physician groups), set by practice size. The fee is a percentage of insurance payments; copays, prenatal self-pay and the patient share of a delivery carry 0%. Setup is $0.

Month to month. Leave with 30 days' written notice. No termination fee. Cap: Percentage fees and mailed statements are capped at 9.0% of that month's insurance payments; the $400 minimum still applies from invoice 4. Minimum: Invoices 1–3: only percentage fees on that month's insurance payments, plus any statements or add-ons you order; the $400 minimum starts with invoice 4. The size rule, add-ons and every segment sit on the full rate card.

Switching your OB/GYN billing to us: how we start

An OB/GYN handover puts two kinds of claims at risk first: aged claims near their deadlines and antepartum visits nobody has billed yet. Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. Every inherited claim within 30 days of a filing, corrected-claim or appeal deadline is worked within 5 business days of access. Starts at access; covers up to 250 claims (more gets a day-1 deadline schedule); worked means submitted, corrected, appealed or returned with the fix.

What your practice provides to start:

1. Your signed service agreement and BAA.
2. Practice-management and clearinghouse logins.
3. A claim-level aging export, so near-deadline claims are sorted on day one.
4. A list of current pregnant patients with due dates, visit counts so far and any transfers.
5. A 45-minute kickoff call with your practice manager.

What to request from your current company is in our billing handoff plan. Want every unpaid claim over 90 days sorted by deadline first? Ask for The Free A/R Deadline Map. Clock starts with your claim-level aging export and signed BAA; above 10 requests in a week, we confirm your date within 1 business day.

Reporting, standards and guarantees for your OB/GYN claims

Two guarantees back your OB/GYN billing, each with its terms:

• On-Our-Watch Guarantee: If a claim misses a filing, corrected-claim or appeal deadline while it is on our watch, we pay you what it would have paid. Claims we get complete 10+ business days before the deadline; contracted rate less any copay you collected, paid automatically within 30 days of final denial; capped $10,000/month; your holds excluded. On antepartum claims, it applies once the visit count closes and the claim is complete, on the terms above.
• Clock-or-Credit Guarantee: From go-live, every new claim goes out within 1 business day of complete charge data, and every denial is worked within 2 business days of posting — or $25 comes off your invoice for each late one. Mon–Fri ET business days by your system's timestamps; worked: resubmitted, appealed or returned with the fix; auto-credited; capped at monthly fee; clearinghouse outages excluded.

Standards we commit to on your system's clock

Every timing below is measured by timestamps in your own system. Each month you get clean claims, A/R days and net collection rate, each with its written definition, and two OB/GYN counts: open pregnancies with antepartum visits not yet billed, and maternity claims waiting on a delivery by another practice. Our denial management team works OB/GYN denials to that clock.

We publish client results only with written permission. Until we have them, judge us by the guarantees and the free Deadline Map.

Your systems, new obstetricians and data access

Your OB/GYN billing stays in the systems you already run. We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day. No patient data moves before a signed BAA, and our EHR compatibility page shows how a system is confirmed.

When an obstetrician or gynecologist joins your group, we file their enrollment with the payers you choose. New-Clinician Enrollment: Clinicians who join while you're a client get enrollment filed with up to 5 payers each (the payer decides), with no per-payer fee. Beyond that, Credentialing & Payer Enrollment is $149 per payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. Our prior authorization service tracks approvals for scheduled gynecologic surgery; the plan decides.

Common questions

How much do your OB/GYN billing services cost?

Your rate depends on size: 6.0% for 1 clinician, 5.5% for 2–5 clinicians, 5.0% for 6–15 clinicians, all of insurance payments. We take 0% of patient payments, and setup costs $0. The medical billing rate card lists every specialty.

Do we sign a long-term contract for OB/GYN billing?

No. Month to month. Leave with 30 days' written notice. No termination fee. Under our Clean-Exit Terms: Notice by email; optional run-out covers claims we submitted before your exit date, at your plan rate; handover file within 10 business days of exit. Open antepartum and delivery claims go into that handover file.

How fast can you take over our OB/GYN claims?

Your first claims go out within 5 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. Send your list of current pregnant patients with due dates on day one, so visit counts and 2027 flags are ready in the first week; the rest is under how we start.

Can you handle our patients who are due in 2027?

Yes. We flag each patient due on or after January 1, 2027, ask your clinicians to record decision making or time at every prenatal visit, and confirm each plan's transition policy before its first claim. Any code change goes to your clinician for sign-off; the detail is under patients due in 2027.

Do you bill split and transfer-of-care maternity claims?

Yes. We log every transfer in and out and bill only the phase of care your practice gave: antepartum visits, the delivery, postpartum care or a combination. When another practice delivers, your antepartum visits are billed once the count closes, not held.

Do you bill LARC placed at delivery separately from the delivery?

Yes. ACOG recommends that contraception placed at or near delivery be billed apart from the delivery, so we put the insertion, and the device when your practice supplied it, on their own lines.

Do you work in the EHR our OB/GYN practice already uses?

Yes. We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day.

Can you enroll a new obstetrician with our payers?

Yes. New-Clinician Enrollment covers obstetricians and gynecologists who join while you are a client; payer count, fee and terms are under systems and credentialing.