Who we serve · OB/GYN
OB/GYN practices. One pregnancy, billed as one package, whoever pays for it.
HRI Med is set up to run enrollment, billing and denials for independent OB/GYN practices, on the methods HRI uses for its behavioral-health clients. We enroll the practice and every clinician with each payer, bill the obstetric package the way each plan reads it, and follow everything billed outside it until paid.
One package, and everything billed beside it.
Routine obstetric care is billed as a package. Under the national correct coding rules, the total obstetric codes, such as CPT 59400 for a vaginal delivery and 59510 for a cesarean, cover the antepartum visits, the delivery and the postpartum care on one claim.A
Ultrasound, amniocentesis, genetic screening, visits for problems unrelated to the pregnancy and the extra visits of a high-risk pregnancy are billed on their own.A Each plan sets its own authorization and frequency rules for them, and we write those down.
When a patient changes plans mid-pregnancy, the package cannot go out as one claim. UnitedHealthcare's commercial policy, for one, names a change of insurer as a reason to itemize, and reports the visits each plan covered with the antepartum-only codes 59425 or 59426.B We bill each payer for its own share, dated to its own coverage.
The birth itself is two claims. The hospital bills its facility claim, and the practice bills the professional delivery with the place of service set to the inpatient hospital (21) or a birthing center (25).C A physician can be in network where the hospital is not, so we check both before the due date.
Medicaid runs through managed-care plans in many states, and federal rules require each of those plans' network providers to be enrolled with the state as well.D States also hold a permanent federal option to extend postpartum coverage, so visits a practice once wrote off may now be billable.E
On the gynecology side, well-woman visits and FDA-approved contraception are generally covered at no cost to the patient when an in-network provider delivers them.F That rule only helps a practice the plan has on file.
Enrollment first, then every claim a pregnancy produces.
- Enrollment
- The practice and every physician, certified nurse-midwife and nurse practitioner, with Medicare, your state's Medicaid and each managed-care plan, and the commercial plans your patients carry. Each one tracked to an effective date.
- The obstetric package
- Coverage checked at the first visit and whenever it changes, so a split pregnancy is billed to the right payers.
- Services outside the package
- Ultrasounds, genetic screening and high-risk visits authorized where the plan requires it and billed on their own claims.
- Claims, posting and denials
- Payments matched to what each plan owes. Every denial traced, appealed where the practice is owed, and fixed at the source.
| Piece of work | Fee |
|---|---|
| The practice, with each payer | $350 |
| Each physician, nurse-midwife or NP, with each payer | $250 |
| A clinician's CAQH ProView profile (CAQH now operates as DataSpring), built or repaired | $150 |
| Billing and the revenue cycle | By agreement |
Total your own enrollment with the calculator.
Common questions from OB/GYN practices.
A patient switched plans halfway through her pregnancy. How is the care billed?
In parts. Each plan is billed for the care given while it covered her, with the antepartum visits reported separately from the delivery and postpartum care, following that plan's written policy.
We are adding a certified nurse-midwife. Where do we start?
With the plans most of your patients carry. The practice is already on file, so each plan takes one practitioner application at $250, plus $150 if the CAQH profile needs building.
Our ultrasound claims keep coming back. Can you find out why?
Yes. We sort the denials by cause, such as a missing authorization, a frequency limit or a code bundled into the package, and work each group. How billing runs
Sources
- CMS, Medicaid NCCI Policy Manual, Chapter VII, section G. Read 2026.
- UnitedHealthcare, commercial Obstetrical Policy, Professional. Read 2026.
- CMS, Place of Service Code Set. Read 2026.
- 42 CFR 438.602(b), managed-care network providers. Read 2026.
- CMS, FAQs on extended postpartum coverage. Read 2026.
- HealthCare.gov, preventive care for women. Read 2026.
Send us your clinicians and the plans your patients carry.
We set your enrollment against that list, plan by plan, and show you where the gaps are. The review needs no patient information.
Say which hospitals your clinicians deliver at.