- 410 Peachtree Pkwy, Suite 4245 Cumming, GA 30041
- Email: info@prohealthcareadvisors.com
- Services
Medical Billing and Practice Management
Creative Collection Solution
MD Audit Shield – RAC
Physician Credentialing
EMR/EHR Software
Electronic Fund Transfer (EFT)
CodeMAXX Services
Hippa
OB-GYN Medical Billing & Credentialing — Built for Obstetrics, Gynecology & Women's Health Groups
OB-GYN medical billing runs on a payment structure no other specialty uses — a global maternity package that spans nine months and two care settings, unbundles the moment a patient transfers in or switches insurance mid-pregnancy, pays twins differently at every payer, and now collides with 12-month postpartum coverage models that redraw where the global ends.
Pro Health Care Advisors delivers end-to-end OB-GYN medical billing and credentialing built for obstetric groups, gynecologic surgeons, midwifery programs, and multi-site women's health organizations — focused on Global Maternity Integrity, Delivery Revenue Accuracy, and Net Realized Revenue Growth.
Why Practices Trust Our OB-GYN Medical Billing Expertise
Generic billing vendors treat a pregnancy like one big code. It isn't. One patient can arrive mid-pregnancy from another practice, switch insurance in the third trimester, deliver twins by cesarean with an assistant, and return for postpartum care under a 12-month coverage model — and every one of those events changes what gets billed and to whom. Our OB-GYN medical billing specialists work these exact scenarios every day, holding each claim to AAPC-certified coding standards before it leaves your practice.
Global Maternity Package Mastery
The 59400/59510 globals bundle antepartum visits, delivery, and postpartum care — until a transfer of care, a mid-pregnancy payer switch, or a high-risk complication breaks the package into itemized components (59425/59426, delivery-only, 59430).
We model global vs. itemized on every OB episode, bill each payer for exactly the services rendered under their coverage window, and align postpartum billing with the Medicaid 12-month postpartum coverage models now active in nearly every state.
Twin, High-Risk & Complication Billing
Multiple gestation pays differently at every payer — modifier 22 on the global at some, a second delivery code with modifier 51 at others. Add assistant-at-cesarean (80/AS) and complication E/M visits with distinct diagnoses, and delivery revenue becomes a payer-by-payer decision we make correctly every time.
OB Ultrasound & Antepartum Testing
Growth scans (76805/76811), NSTs (59025), and BPPs sit outside the global — but inside frequency limits and medical-necessity edits. We document indications so high-risk surveillance is paid, not bundled.
Gynecologic Surgery & Robotic Documentation
Hysteroscopy, LEEP, and hysterectomy families carry 90-day globals and increasingly robotic-specific documentation requirements. Our op-note templates satisfy payer medical-necessity audits before they're ever requested.
LARC & Preventive Care Economics
IUD and implant billing pairs a procedure (58300) with a buy-and-bill device J-code — and ACA rules protect patient cost-sharing on both. We reconcile device margin, insertion billing, and well-woman + problem-visit combinations (modifier 25) so preventive revenue stays whole.
Dedicated Women's Health Account Team
A named Account Manager plus OB-trained specialists — not a generic call center. A team that knows your delivery volume, your payer mix, and your midwifery arrangements.
OB-GYN Medical Billing Across the Full Code Spectrum
From global maternity packages and antepartum testing to gynecologic surgery, LARC, and preventive care — our AAPC-certified coders handle the complete women's health claim spectrum, with CodeMAXX coding review on every claim.
9 Comprehensive OB-GYN Medical Billing & Credentialing Services
Standard vendors process claims. We engineer maternity revenue integrity. Groups searching for dependable OB-GYN billing services get the complete stack in one engagement — global modeling, payer-switch tracking, and LARC economics included as standard, not as add-ons.
OB Benefits Verification & Episode Tracking
We verify maternity benefits at intake and track every insurance change across the pregnancy — connected to your EHR through our EMR/EHR software service — so a third-trimester payer switch never voids nine months of billing.
OB Coding & Diagnosis Precision
Certified coders validate O-codes with correct trimester digits, Z3A gestational weeks on every claim, and delivery outcome coding. Our CodeMAXX service audits each episode before submission.
Prior Auth for Genetic Testing & High-Risk Scans
NIPT and prenatal genetic screening criteria, growth-scan authorizations, and real-time clinical uploads — tracked to payer-specific timelines so high-risk care never waits on paperwork.
Claims Submission & Global-Aware Scrubbing
OB-specific scrubbing covers global vs. itemized logic, twin delivery rules per payer, ultrasound frequency edits, and LARC device pairing on every claim.
Denial Management & Medicare Appeals
We eliminate repeat denials — missing Z3A weeks, global bundling errors, device mismatches — and file appeals through all five levels per the CMS Medicare appeals process.
Payment Posting & Variance Detection
Automated remittance processing with contracted-rate variance flagging across your OB-GYN medical billing — when a payer underpays a twin delivery or misprices a global, we catch it and dispute it formally.
Maternity Patient Billing & Payment Plans
Nine months of care produces confusing statements without careful design. Our OB-GYN medical billing workflows build episode-based patient billing with payment plans — protecting reviews and referrals in a specialty built on trust.
OB-GYN & Midwife Credentialing
Our credentialing team manages physician CAQH and payer enrollment, OB hospital privileges, CNM enrollment under their own benefit, ultrasound accreditation upkeep, and monthly OIG/SAM sweeps.
OB-GYN RCM Analytics & Reporting
Days in AR, global vs. itemized capture rates, delivery revenue per payer, and LARC device margin — part of our full medical billing and practice management platform.
Your Women's Health Revenue Cycle Is Leaking. We'll Show You Where.
Most OB-GYN groups lose 8–12% of potential revenue to broken globals, underpaid twin deliveries, and LARC devices billed below cost. Get a complimentary OB-GYN Payer Performance Audit — benchmarking your current OB-GYN medical billing performance with zero obligation.
No sales pitch. No obligations. Just data.
OB-GYN Medical Billing for Every Practice Model
Each model bills differently — delivery globals vs. office gynecology volume, hospital privileges vs. birth-center facility claims, surgical globals vs. fertility cash-pay hybrids. We staff for all of them, with OB-GYN medical billing workflows tuned to each model's episode mix.
Private OB-GYN Group Practices
Full-spectrum billing — global maternity episodes, office gynecology, preventive care with modifier 25 combinations, and in-office ultrasound with frequency-edit management for multi-physician groups.
Hospital-Affiliated Obstetrics & Laborists
Delivery-only billing (59409/59514), split antepartum/postpartum arrangements, assistant-at-cesarean claims, and the transfer-of-care documentation hospital-based OB demands.
Midwifery Programs & Birth Centers
CNM enrollment under their own payer benefit, birth-center facility billing, collaborative-agreement compliance, and Medicaid maternity models covering the deliveries midwives attend.
Gynecologic Surgery & MIGS Practices
Hysterectomy and hysteroscopy families with 90-day globals, robotic documentation requirements, co-surgeon logic, and the pathology coordination surgical gynecology generates.
Fertility & REI Practices
Infertility benefit verification with medical-necessity coding boundaries, cash-pay and insurance hybrid workflows, and genetic-testing authorization chains for assisted reproduction programs.
Urogynecology & Pelvic Floor Practices
Pelvic floor therapy coding, urodynamics with 26/TC splits, mesh and sling procedure documentation, and the medical-policy depth reconstructive OB-GYN medical billing claims require.
High-Impact OB-GYN Medical Billing Items We Manage Daily
These claim elements drive the majority of OB-GYN medical billing revenue — and the majority of denials. Global math, episode tracking, and diagnosis precision are where our team earns its keep.
| Claim Element | Category | Common Denial / Loss Trigger | Our Safeguard | Status |
|---|---|---|---|---|
| Global unbundling events | Transfers · payer switch | Full global billed after partial care — or itemized revenue lost | Episode tracking with global vs. itemized modeling | ✓ Covered |
| Twin & multiple gestation | Delivery payment | Second baby billed wrong for that payer's rule | Payer-specific twin logic (22 vs. 51 pathways) | ✓ Covered |
| Z3A gestational weeks | Diagnosis coding | Missing weeks code — automatic OB claim rejection | Z3A validation on every antepartum claim | ✓ Covered |
| OB ultrasound frequency | 76805–76817 | Growth scans denied past payer limits | Indication documentation + frequency tracking | ✓ Covered |
| LARC device pairing | 58300 + J-codes | Device and insertion mismatched or underpriced | Buy-and-bill reconciliation per device | ✓ Covered |
| Well-woman + problem E/M | Modifier 25 | Preventive and problem visit bundled automatically | Dual-documentation note standards | ✓ Covered |
| Extended postpartum care | 12-month models | Separately billable visits absorbed into the global | Postpartum window mapping per payer | ✓ Covered |
Getting Started with OB-GYN Medical Billing: Our 5-Step Onboarding
From your first free assessment through full OB-GYN medical billing management — onboarding takes less than two weeks.
Free Practice AR Assessment
We analyze your OB-GYN medical billing performance — global capture accuracy, twin delivery payments, LARC margins, and denial patterns by payer.
Credentialing & Privileges Audit
We verify physician CAQH profiles, OB hospital privileges, CNM enrollments, and ultrasound accreditation status — closing gaps before they interrupt delivery revenue.
EHR & Episode Integration
We connect to your platform — Epic, athenahealth, eClinicalWorks, and more — including OB flowsheets, no migration required.
Active Billing & Compliance
Certified coders run claims from prenatal intake to postpartum close-out with continuous global, modifier, and diagnosis monitoring.
Monthly Practice Reporting
Real-time dashboards plus monthly optimization recommendations for your OB-GYN medical billing performance.
Built-In RAC Audit Defense for Every OB-GYN Medical Billing Client
Global-period integrity and delivery documentation draw focused payer review — and Medicaid's outsized role in maternity care adds state audit exposure most specialties never face. Every women's health engagement therefore includes MD Audit Shield as a built-in layer — prevention designed into daily billing, with full federal defense ready if a review ever lands.
Proactive — Not Reactive
Global boundaries, episode events, and diagnosis pairs are checked as claims are built — so an auditor's records request finds documentation already in order.
AAPC-Certified Coding Accuracy
Certified coders verify every delivery code, modifier pathway, and Z3A pairing against current payer policy — removing the maternity patterns reviewers screen for.
All 5 Medicare Appeal Levels
Our appeals unit takes cases from Redetermination up through Federal District Court with OB-specific documentation packets prepared for each stage.
HIPAA-Compliant Workflows
Prenatal records, ultrasound images, and patient data travel only through AES-256 encrypted channels under managed BAAs.
Real-Time Compliance Reporting
Global capture rates, audit risk indicators, open appeals, and compliance metrics update live in dashboards your practice manager can open anytime.
Dedicated Audit Response Team
One named specialist owns your account end to end — when a payer letter arrives, your response is already assigned, not waiting in a queue.
OB-GYN Medical Billing — Frequently Asked Questions
With Medicaid programs in nearly every state — and a growing number of commercial payers — extending postpartum coverage to 12 months, practices must separate what belongs inside the global maternity package from extended postpartum care that is separately billable.
Our OB-GYN medical billing team structures global vs. itemized billing around each payer's postpartum model — so extended maternal care is captured instead of absorbed.
Payers increasingly require operative notes to include the specific robotic platform utilization data behind robotic add-on reporting for pelvic procedures.
We build documentation templates that satisfy payer-specific medical-necessity audits — so robotic hysterectomy and myomectomy cases are paid, not pended for records.
Yes, when a significant, separately identifiable issue is addressed during the preventive visit. NCCI edits allow the problem E/M with modifier 25 — but documentation must clearly separate the preventive service from the problem evaluation.
We build note standards that support both services — protecting a combination payers bundle automatically.
Largely, yes. Many payers now run real-time maternal-access portals that let high-compliance practices bypass standard review for NIPT and genetic screens.
We manage payer-specific criteria and clinical uploads — so high-risk pregnancies get testing without authorization delays, and your practice gets paid at correct rates.
Every location needs correct site-of-service enrollment for every NPI — satellite wellness clinics are the classic gap that triggers out-of-network denials.
For every site, our credentialing team keeps an NPI-level enrollment matrix current, watches remittance advisories, and opens formal prompt-payment disputes the moment a payer overruns a statutory window.
Explore More Medical Billing & Credentialing Resources
OB-GYN medical billing is one of 30+ specialties we serve nationwide.
Pediatrics Medical Billing & Credentialing
Every delivery hands off to a pediatrician — newborn care coding, vaccine schedules, and the Medicaid/CHIP coordination your patients' families depend on next.
Pediatrics Billing →Family Practice Medical Billing & Credentialing
Well-woman care, preventive-plus-problem visit logic, and chronic care management overlap heavily with family medicine's billing playbook.
Family Practice Billing →OB-GYN & Midwife Credentialing Services
Full-lifecycle credentialing — CAQH management, OB hospital privileges, CNM own-benefit enrollment, and OIG/SAM exclusion monitoring.
Credentialing Services →30+ Medical Billing Specialties We Serve
From otolaryngology and gastroenterology to pathology and behavioral health — explore every specialty-specific billing program we offer.
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