≥95%
First Pass
5–15%
Clean claim accuracy target
Obstetrics Billing Workflow
Recovery SpecialistsHIPAA Certified98% Claim Accuracy30% Revenue Boost Avg24h Turnaround100+ US PracticesAI-Powered RCMDenial Recovery SpecialistsRecovery SpecialistsHIPAA Certified98% Claim Accuracy30% Revenue Boost Avg24h Turnaround100+ US PracticesAI-Powered RCMDenial Recovery SpecialistsWhen prenatal care, delivery, or postpartum care is divided between providers, one full global maternity code may no longer represent the episode accurately.
Incorrectly packaging care can delay payment or leave separately reportable work outside the claim.
We verify antepartum visit counts, transfer dates, delivering provider, and postpartum responsibility before selecting the appropriate billing route.
Procedures, drugs, and device-related services may require payer approval supported by specific clinical records before treatment.
When authorization requirements are identified after care is delivered, the practice may commit resources without meeting payer conditions.
We match authorization requests with indications, notes, imaging, labs, approved dates, and units before billing.
CMS permits Modifier 25 only for significant separately identifiable E/M services, while NCCI modifiers require qualifying clinical circumstances.
Unsupported modifiers can trigger coding edits, while missing supported modifiers can leave legitimate services unreported.
Our coders tie modifiers to the E/M note, procedure performed, timing, and documented clinical distinction before submission.
The ultrasound ordered, study performed, physician interpretation, diagnosis, and CPT selection must tell the same clinical story.
Conflicting elements can turn a completed diagnostic service into a coding or medical necessity issue.
We reconcile indication, gestational context, report, diagnosis linkage, and ultrasound code before billing.
The contraceptive procedure and device supply are not automatically the same charge, and same-day E/M reporting requires separate support.
Missing supported device, procedure, or separately identifiable service means part of the encounter may never reach the payer correctly.
PROMBS reconciles device supplied, procedure performed, HCPCS reporting, E/M documentation, and applicable modifier as one complete billing event.
Transfer timing, antepartum visits, delivery responsibility, and postpartum care can move the same pregnancy from global billing to component reporting.
Modifiers 25 and 59 require documented separation between services; without that distinction, payer edits can collapse separately reported work into bundling.
Medicaid and commercial plans can apply different maternity, authorization, and bundling rules, so identical care may follow different claim pathways.
New obstetric CPT codes take effect January 1, 2027, making service dates, payer adoption, and antepartum reporting impossible to treat casually.
First Pass
Denial And Rejection Rate
Drug Claims
Appeals
A/R Aging
Collections
Variance
Authorization
Our experts understand complex vascular procedures, payer requirements, and specialty-specific coding needs across diverse healthcare markets.
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