Nationwide OB/GYN billing, delivered remotely
Medical billing is one of the few practice functions that doesn't depend on being down the hall. We work inside your existing practice management and EHR system with secure, individual user accounts, communicate through WhatsApp, email and scheduled calls, and send you a monthly report you can review from anywhere. That means an independent OB/GYN practice in rural Montana gets the same specialized billing team as a multi-provider group in Houston or northern New Jersey.
What does change from state to state is the payer landscape. Medicaid programs, managed care plans, Blue Cross Blue Shield licensees, state insurance mandates and telehealth rules all vary by state. Over more than eight years of OB/GYN billing, we've built payer-specific rules for the plans our clients bill most, and we research the details for every new state before onboarding a practice there.
Why state-specific knowledge matters for OB/GYN billing
Medicaid is central to obstetric revenue
Medicaid pays for a large share of births in the United States, so how your state's Medicaid program handles maternity care has an outsized effect on an obstetric practice's revenue. States differ on:
- Fee-for-service vs. managed care. Most states deliver Medicaid through managed care organizations (MCOs), each with its own prior authorization rules, claim edits and appeal process.
- Obstetric billing policy. Some programs and plans want the global package billed after delivery; some require a pregnancy notification or a first-visit claim; some allow or require antepartum visits to be billed as they happen.
- Presumptive eligibility. Many states let pregnant patients receive care while their full Medicaid application is processed — which creates its own billing timing questions.
- Postpartum coverage. Most states have extended postpartum Medicaid coverage to 12 months, which changes how postpartum care beyond the global period is billed and to whom.
Commercial payers vary by region
The largest commercial payers in Texas aren't the same as those in New Jersey or California. Blue Cross Blue Shield is a different company in nearly every state, each with its own medical policies. Regional plans and provider-owned plans add more variation. We keep a playbook for each payer our clients work with: timely filing limits, authorization requirements, modifier preferences, appeal procedures and known quirks.
State insurance mandates
Several areas of women's health are shaped by state law rather than federal rules:
- Fertility coverage. A growing number of states mandate some level of infertility or fertility preservation coverage for fully insured plans. Self-funded employer plans aren't subject to these mandates, which is why we verify benefits plan by plan. See infertility & REI billing.
- Telehealth. States set their own rules for Medicaid telehealth coverage and, in many cases, for commercial telehealth parity. See telehealth billing.
- Contraception. Some states require coverage of extended contraceptive supplies or specific methods beyond federal requirements.
- Prompt-pay laws. States set deadlines for how quickly commercial insurers must pay clean claims, which strengthens your position on late payments.
Credentialing is state-specific too
Medical licenses, Medicaid enrollment and many managed care credentialing processes are state-based. If your practice operates across a state line — common in the New York–New Jersey area, the DC region and the Kansas City metro — each state's enrollment has to be managed separately. Our credentialing service handles multi-state enrollment.
How we onboard a practice in a new state
- Payer research. We identify your state's Medicaid program, the MCOs active in your area, and the commercial plans in your payer mix, and we document their OB/GYN-relevant policies.
- Free audit. As with every client, we review a sample of your claims, remittances and A/R to see where you stand.
- Rules setup. State and payer-specific edits are added to our claim review process before your claims go out through us.
- Ongoing monitoring. We watch for Medicaid bulletins, payer policy updates and state law changes that affect your billing.
Time zones and communication
WhatsApp lets you reach us whenever it's convenient, and we respond promptly during business hours. Every client has a dedicated point of contact, and we schedule monthly review calls at a time that works for your practice — whether you're on Eastern, Central, Mountain, Pacific, Alaska or Hawaii time.
Practices we serve
Our focus is independent OB/GYN practices: solo physicians, small groups, multi-location groups, and practices with certified nurse-midwives and nurse practitioners. We also work with reproductive endocrinology and urogynecology practices, and with multi-specialty groups that include women's health providers. Outside women's health, we support cardiology and other specialties in every state as well.
Regional payer notes
- Northeast: many practices bill several neighboring states' Medicaid programs and multiple Blue Cross Blue Shield licensees, especially around New York, New Jersey, Pennsylvania and the DC region.
- Southeast: Medicaid managed care is widespread, and obstetric volume often depends heavily on Medicaid plans.
- Midwest: regional and provider-owned health plans play a large role alongside national carriers.
- Southwest: Texas and Arizona practices often work with large Medicaid managed care programs and a mix of national and regional commercial plans.
- West: state-specific programs such as Medi-Cal in California bring their own billing rules and managed care plans.
Ready to talk about your state's payers?
Whether your practice is in Houston, northern New Jersey, Atlanta, Phoenix or a rural community far from any major city, the starting point is the same: a free audit of your claims, denials and A/R. Send us a WhatsApp message with your practice's state and main payers, and we'll take it from there.