New OB/GYN Practice Billing Setup

Why billing setup decides your first year

New practices rarely fail for clinical reasons. They struggle because cash doesn't arrive when expected. In OB/GYN, the risk is higher than in most specialties:

• Payer enrollment takes months, and a new provider or group can't be paid in-network until it's effective.
• Obstetric revenue is delayed by design. Under global billing, a pregnancy that starts in your first month may not be billed until delivery months later.
• A misconfigured system creates silent errors — wrong billing NPI, wrong taxonomy, wrong place of service — that show up as denials weeks later.

Our practice setup service builds the foundation correctly before you see patients. It draws on more than eight years of OB/GYN billing experience — we know what goes wrong in new practices because we've cleaned it up many times.

What's included

Business and provider identifiers

• Type 1 NPIs for each provider and a Type 2 NPI for the practice
• Correct taxonomy codes — 207V00000X for Obstetrics & Gynecology, or subspecialty codes where appropriate (see our taxonomy code guide)
• Coordination with your accountant on the tax ID and entity details payers will require

Payer enrollment and credentialing

• CAQH ProView profiles for every provider
• Medicare enrollment through PECOS, including reassignment to the group
• State Medicaid and Medicaid managed care plans — critical for most obstetric practices
• Commercial plans in your area, prioritized by your expected patient mix

Our credentialing service explains this process in detail.

Practice management and EHR configuration

• Provider, location, billing and rendering NPI setup
• Payer list with correct payer IDs and clearinghouse enrollment (including electronic remittance and EFT enrollment)
• Fee schedule loaded and charge entry templates built
• Claim scrubber rules for OB/GYN-specific edits
• Pregnancy tracking set up so global packages can be billed accurately

Fee schedule and charge master

We help you set a defensible, easy-to-maintain fee schedule, typically based on a multiple of your Medicare locality rates, and build a charge list around the services you'll actually provide. More on our fee schedule optimization service.

Superbill / charge form design

An OB/GYN-specific charge form covering prenatal and postpartum care, preventive visits, problem visits, ultrasounds, LARC procedures, in-office procedures and common surgeries — with the diagnosis codes your providers use most.

Policies and procedures

• Patient financial policy (copays, deductibles, payment plans, self-pay pricing)
• Front-desk procedures for insurance capture and verification
• Obstetric patient financial counseling: explaining maternity coverage up front
• A billing policy manual so your team knows how each workflow runs

Staff training

We walk your front-desk and clinical staff through insurance verification, charge capture and documentation practices that support clean claims.

Typical setup timeline

Opening sooner than that? We'll prioritize the steps that matter most for your payer mix and help you schedule around enrollment status.

Types of practices we help launch

• Solo physicians leaving a hospital-employed or group position to open their own office
• New groups formed by physicians, midwives and nurse practitioners
• Practice acquisitions, where enrollment, ownership changes and A/R from the previous owner need careful handling
• Spin-offs from hospital or health system ownership back to independence
• Satellite locations opened by existing practices

Preparing for the 2027 maternity changes

If you're opening in late 2026 or 2027, you're building your billing around a moving target. The global maternity package codes are deleted for dates of service on or after January 1, 2027, and prenatal and postpartum care will be billed per encounter. We'll configure your system and workflows for the new structure from the start — see our 2027 maternity transition guide.

After launch

Most practices continue with our revenue cycle management service, so the team that set up your billing is also the team running it. If you'd rather bill in-house, we'll hand off a fully documented setup and can provide periodic coding audits to keep things on track.

The cash-flow reality of a new OB/GYN practice

It helps to plan for how revenue actually arrives in a new obstetric practice. Office gynecology and problem visits are paid within weeks of the visit once enrollment is effective. Surgical cases are paid after the procedure, provided authorizations were in place. Obstetric care billed under the global package — through 2026 — isn't paid until after delivery, which may be months after the first prenatal visit. In 2027, prenatal visits will be billed per encounter, which will change the cash-flow curve for new practices that open then.

That means a new practice should budget for a ramp-up period. We help you build a realistic projection based on your expected patient mix, payer enrollment timeline and the billing rules that apply, so there are no surprises in your first six months.

New practice setup checklist

Use this as a starting point — we customize it for every practice:

• Legal entity formed and tax ID obtained
• Type 1 NPI for each provider; Type 2 NPI for the practice; taxonomy codes confirmed
• Business bank account for EFT deposits
• Malpractice coverage in place for each provider
• CAQH ProView profiles complete and attested
• Medicare PECOS enrollment and reassignment submitted
• State Medicaid and Medicaid managed care applications submitted
• Commercial payer applications submitted, prioritized by expected volume
• Hospital privileges for delivering and operating providers
• EHR/PM system selected, contracted and configured
• Clearinghouse, ERA and EFT enrollment for each payer
• Fee schedule set and loaded
• Charge forms and order sets built for OB/GYN services
• Patient financial policy and consent forms written
• Front-desk insurance verification workflow trained
• First week of claims reviewed before submission

Mistakes we help new practices avoid

• Billing under a former employer's group NPI or tax ID
• Seeing patients from plans where enrollment isn't yet effective — without a plan for those claims
• Forgetting ERA/EFT enrollment, so payments arrive as paper checks months later
• Setting fees too low "to be competitive" and capping reimbursement from every payer
• Building the EHR without OB-specific pregnancy tracking, making global billing a manual reconstruction later

Get a free launch checklist

Send us a WhatsApp message with your planned opening date, location and the payers you intend to accept. We'll send back a customized setup checklist and timeline — no form and no cost.