Obstetrics billing is different from most medical billing because one episode of care can extend across many months.
A patient may receive prenatal care from one practice, change insurance during pregnancy, transfer to another provider, deliver at a different facility, and receive postpartum care under yet another coverage period.
That creates one of the most important obstetrics billing challenges:
The clinical pregnancy may be continuous, but billing responsibility may not be.
The revenue cycle therefore needs to track much more than the delivery date.
A useful workflow is:
Eligibility → Antepartum Care → Coverage Changes → Provider Responsibility → Delivery → Postpartum Care → Claim → Payment → Denial → A/R
If any part of that maternity episode is classified incorrectly, the resulting claim can be delayed, denied, underpaid, or duplicated.
Why Are Obstetrics Billing Challenges Different From Routine Medical Billing?
Most office claims represent a specific encounter on a specific date.
Traditional maternity billing can combine months of services into one payment structure.
Under the current 2026 model, global obstetric CPT codes can include routine antepartum care, delivery, and postpartum care when the same eligible physician or group provides the qualifying components.
Common global codes include:
- 59400 for routine obstetric care with vaginal delivery and postpartum care
- 59510 for routine obstetric care with cesarean delivery and postpartum care
- 59610 for routine obstetric care with vaginal delivery after a previous cesarean
- 59618 for routine obstetric care with cesarean delivery following an attempted vaginal delivery after a previous cesarean
ACOG also notes that payer policies differ in how obstetric services are reported, which means practices cannot assume every insurer handles maternity claims identically.
This creates complexity when the maternity episode does not follow the expected path.
Where Does Obstetrics Revenue Usually Break Down?
Problems can occur at almost every stage of the pregnancy.
| Billing Area | Common Revenue Risk |
|---|---|
| Global Maternity | Full package billed when care was actually split |
| Antepartum Care | Visit count or billing responsibility is incorrect |
| Transfer of Care | More than one provider claims the same maternity component |
| Eligibility | Coverage changes during the pregnancy |
| Delivery | Wrong provider or billing structure is used |
| Postpartum | Responsibility for postpartum care is unclear |
| Payer Rules | Insurer uses a different maternity methodology |
| Denials | Episode components do not match the claim |
The billing team therefore needs to understand who provided which part of the maternity episode and under what coverage.
Challenge 1: Global Maternity Billing Is Used When the Full Package Was Not Provided
The global maternity package is convenient when one eligible physician or group manages the qualifying antepartum care, delivery, and postpartum services.
Problems arise when staff assume every pregnancy qualifies for global billing.
The full package may no longer reflect the actual episode when:
- The patient transfers into the practice late
- The patient transfers out before delivery
- Another unrelated physician delivers the baby
- Antepartum care is divided between practices
- Postpartum care is provided elsewhere
- Insurance changes affect how the services must be reported
In those situations, the billing team needs to determine which maternity components were actually provided.
Using a global code simply because the practice participated in the pregnancy can create duplicate or inconsistent claims.
Challenge 2: Transfers of Care Break the Global Package
Transfer of care is one of the most difficult maternity billing situations.
A patient may change obstetric providers because of:
- Relocation
- Insurance network changes
- Referral to a higher level of care
- High-risk pregnancy
- Patient preference
- Change in hospital or delivery plan
The billing team must identify the exact date responsibility changed.
It should then determine:
- How many antepartum visits each practice provided
- Which provider or group performed the delivery
- Who provided postpartum care
- Whether the providers belong to the same billing group
- Which payer covered each stage
This is not merely administrative detail.
ACOG has specifically identified transfer-of-care payment problems as one of the weaknesses of the traditional global obstetric model. The upcoming 2027 restructuring is intended in part to make payment more reflective of maternity care that is divided among different professionals and teams. Follow us on LinkedIn to get more information.
Until that transition is complete, practices still need accurate episode-level tracking.
Challenge 3: Antepartum Visit Counts Are Not Tracked Correctly
Partial antepartum care requires special attention.
Under the current coding structure, 59425 can be used for four to six antepartum visits and 59426 for seven or more antepartum visits when applicable. Fewer visits may instead require individual E/M reporting, depending on the circumstances and payer policy. ACOG also notes that these antepartum-only codes are being deleted in 2027 as the maternity coding structure changes.
This makes visit-count tracking essential.
A practice should know:
- Date of first prenatal visit
- Number of antepartum visits provided
- Date care transferred in or out
- Payer during each stage
- Whether care qualifies for global or partial reporting
Without this information, billing staff may use the wrong maternity structure.
The result can be:
Incorrect Code → Payer Edit → Claim Correction → Payment Delay
Challenge 4: Delivery and Postpartum Responsibility Are Unclear
Another common problem occurs when one provider performs the delivery but another practice handled much of the prenatal care.
The billing team should not assume delivery automatically gives one practice ownership of the full global maternity package.
Current obstetric coding includes delivery-only and delivery-with-postpartum options for circumstances where the full global package is not appropriate.
For example, ACOG identifies current delivery-only codes such as:
- 59409
- 59514
- 59612
- 59620
ACOG notes that these codes currently include labor management from admission through delivery and completion of immediate postpartum orders, while other maternity services may require separate reporting depending on the episode.
The key question is:
What did this provider actually manage?
Not:
Who submitted the claim first?
Challenge 5: Services Outside the Global Package Are Missed or Double-Billed
Global maternity billing does not mean every service performed during pregnancy is automatically part of the package.
Some separately identifiable services may need their own coding and reimbursement when supported.
At the same time, services already included in the maternity package should not be billed again simply because they appear separately in the record.
That creates two opposite revenue risks.
Missed Revenue
The practice fails to identify a legitimately separate service.
Duplicate Billing
The practice separately reports a service already included in the maternity package.
CMS coding guidance has historically identified certain routine obstetric services as included in maternity procedure codes rather than separately reportable.
The billing team therefore needs to distinguish between:
Included maternity care and separately reportable care.
This should be determined from current coding guidance, documentation, and payer policy rather than assumptions.
Why Do Payer Differences Make Global Maternity Billing Harder?
Even when the clinical episode is straightforward, the payer methodology may not be.
ACOG notes significant variation in maternity billing. Some Medicaid programs use global maternity codes, others require visit-level billing, and some use a combination of approaches.
Commercial payer requirements can also differ.
That means the same maternity episode may require a different billing workflow depending on the patient’s coverage.
The practice should know:
- Which payer is responsible
- Whether the payer accepts global reporting
- How partial care is reported
- Whether specific modifiers are required
- How transferred care is handled
- Which filing limits apply
A generic “this is how we always bill maternity” workflow can therefore create preventable denials.
How Do Global Maternity Errors Turn Into Lost Revenue?
Global maternity mistakes often create a chain reaction.
Consider a patient who received prenatal care from one group and later transferred to another.
If the first practice incorrectly submits a full global claim, the payer may reject or deny claims submitted by the delivering provider.
The practices then need to determine:
- Which services each one performed
- Which claims should be corrected
- Which codes apply
- Which payer was responsible
- Whether timely filing or appeal deadlines are approaching
The revenue path becomes:
Incorrect Maternity Structure → Claim Conflict → Denial → Correction → Payer Follow-Up → Aging A/R
A mistake made months earlier can therefore delay reimbursement long after delivery.
Why Is Late 2026 Especially Important for Obstetrics Billing?
Obstetric billing is currently in a major transition.
ACOG and the AMA have revised maternity coding so that the longstanding global obstetric codes will be replaced by a new code structure beginning January 1, 2027.
ACOG has also recommended transition activity during 2026. For relevant pregnancies beginning late enough to continue into 2027, it recommends moving toward individual E/M reporting for antepartum visits, with transition guidance beginning September 1, 2026.
This means practices now have two responsibilities:
Bill current 2026 maternity care correctly while also preparing pregnancies that cross into 2027 for a different coding structure.
We will examine that transition in more detail in Part 2.
What Should an Obstetrics Practice Fix First?
Start by making every maternity episode visible.
For each pregnancy, the billing team should be able to identify:
- Current payer
- Previous payer when coverage changed
- First antepartum visit
- Number of prenatal visits
- Provider or group responsible for antepartum care
- Transfer-of-care date
- Delivering provider
- Delivery type
- Postpartum responsibility
- Global vs split billing status
- Outstanding claims
- Denials
- A/R
The goal is to connect the entire maternity episode before billing decisions are made.
That is the foundation for solving obstetrics billing challenges before they become payer disputes, denials, and aging revenue.
Challenge 6: Insurance Changes During Pregnancy
One of the hardest obstetrics billing challenges occurs when a patient’s insurance changes before delivery.
Pregnancy may extend across several months, during which coverage can change because of:
- Employer plan changes
- Loss of previous coverage
- Medicaid enrollment
- Commercial plan enrollment
- Network changes
- Relocation
- Changes in dependent coverage
The clinical episode continues, but the payer responsible for individual dates of service may change.
That makes maternity billing more complicated than simply checking which insurance is active on the delivery date.
The practice needs a clear coverage timeline.
Pregnancy Timeline → Coverage Dates → Antepartum Services → Delivery → Postpartum Care → Correct Payer
Without that timeline, claims can easily be sent to the wrong insurer or structured incorrectly.
Why Should Eligibility Be Rechecked Throughout Pregnancy?
Eligibility verified at the first prenatal visit does not guarantee that the same coverage will remain active through delivery.
A maternity episode can last long enough for a patient’s insurance situation to change several times.
Practices should consider rechecking eligibility at important points such as:
- Early prenatal care
- Before major procedures or testing
- When the patient reports an insurance change
- Before delivery when practical
- During postpartum care if coverage has changed
Verification should determine more than whether the policy is active.
The billing team may also need to review:
- Effective dates
- Termination dates
- Network status
- Maternity benefits
- Deductible
- Coinsurance
- Referral requirements
- Authorization requirements
- Secondary coverage
A coverage change discovered after delivery can force the practice to reconstruct months of billing activity.
Finding it earlier gives the team more time to determine the correct billing strategy.
What Happens When Coverage Changes Mid-Pregnancy?
There is no single billing rule that applies to every payer transition.
The practice should first determine which insurer was responsible for each part of the episode.
Review:
- Date the original coverage ended
- Date the new coverage became effective
- Antepartum visits under each plan
- Delivery date
- Postpartum dates
- Provider network status under the new plan
- Payer-specific maternity billing policy
The billing team should not assume that one payer will reimburse the entire maternity episode simply because it covered the delivery.
Likewise, billing a full global package without considering earlier coverage can create conflicts when services were provided under different insurance periods.
The safest approach is:
Coverage Timeline → Services Provided → Payer Policy → Correct Claim Structure
Challenge 7: The Practice Assumes Every Payer Uses the Same Maternity Rules
Payer variation is a major source of maternity billing problems.
ACOG notes that maternity reporting is not standardized across insurers. Some Medicaid programs use global maternity codes, some require individual visit billing, and others use a combination of approaches.
Commercial insurers may also have their own:
- Global billing policies
- Antepartum requirements
- Modifier instructions
- Transfer-of-care rules
- Timely filing limits
- Authorization processes
- Transition policies for 2027
This means a billing workflow that works correctly for one payer may create denials with another.
Practices should maintain payer-specific maternity billing guidance instead of relying on a single universal rule.
Challenge 8: Authorization or Referral Information Does Not Follow the Maternity Episode
Authorization problems can occur when care changes during pregnancy.
For example:
- The patient changes provider
- The patient changes payer
- The delivery facility changes
- A planned service changes
- The patient is referred for high-risk care
- The authorization expires before the service
The billing team should verify whether approval is tied to:
- A particular provider
- A particular facility
- Specific services
- A date range
- A number of visits
- A particular payer
An authorization obtained early in pregnancy may not remain valid after the patient’s insurance or care plan changes.
The final claim should therefore be compared with the authorization information before submission.
Challenge 9: Eligibility Information Is Not Connected to Billing
Another common problem occurs when eligibility is verified but the information never reaches the people responsible for coding and claims.
For example, front-office staff may identify a new insurance plan while the billing team continues preparing the maternity episode under the previous payer.
That creates a disconnect between:
Registration → Eligibility → Clinical Care → Billing
Coverage changes should trigger a documented billing review.
The billing team should know:
- What changed
- When it changed
- Which services were already provided
- Which claims have already been submitted
- Whether any claims need correction
- Which payer is expected to handle future services
Eligibility verification has little value if the result does not change the billing workflow.
Challenge 10: Maternity Denials Are Corrected Without Rebuilding the Episode
Maternity denials often require more than correcting one claim field.
The billing team may need to reconstruct the entire pregnancy episode to understand what went wrong.
| Denial Type | What to Review |
|---|---|
| Eligibility | Coverage on each date of service |
| Global Package | Who provided each component |
| Antepartum | Visit count and provider responsibility |
| Delivery | Delivering provider and payer |
| Postpartum | Who provided follow-up care |
| Transfer of Care | Dates and group responsibility |
| Authorization | Approved service, provider and dates |
| Duplicate | Global versus separately billed services |
| Timely Filing | Correct payer and submission timeline |
| Payer Policy | Current maternity billing methodology |
A denial should lead to two questions:
How do we fix this claim?
and
Why was the maternity episode structured incorrectly in the first place?
The second question prevents the same problem from repeating.
Why Is Late 2026 Especially Complicated for Obstetrics Billing?
Obstetrics practices are currently managing both the existing global maternity system and preparation for a major 2027 coding change.
ACOG and the AMA have replaced the longstanding bundled maternity structure with a new obstetric coding framework effective January 1, 2027. The new model separates services more closely according to how prenatal care, labor, delivery, and postpartum care are actually provided.
That makes pregnancies crossing from 2026 into 2027 particularly important.
Practices need to know whether current antepartum services should follow traditional global billing or begin transitioning toward individual E/M reporting.
What Is Changing With Global Obstetric Billing in 2027?
Under the 2027 framework, the traditional global obstetric CPT structure is being replaced.
ACOG explains that maternity care will move toward separately reported services, including existing E/M codes for prenatal and postpartum visits and new codes for labor management and delivery.
The changes are designed partly to address problems created by the old bundled model, including:
- Transfer of care
- Team-based maternity care
- More complex prenatal services
- Telehealth
- Home monitoring
- Payment collection when multiple professionals participate
For billing teams, this means maternity care will increasingly need to be tracked at the individual service level rather than waiting for one global claim after delivery.
Why Are Practices Already Changing Workflows in 2026?
The new codes officially take effect January 1, 2027, but the transition affects pregnancies already underway.
ACOG recommends that health plans move toward E/M billing for antepartum visits no later than September 1, 2026, particularly for pregnancies that will continue into 2027. It recommends the TH modifier with the E/M code to identify maternity care during this transition.
ACOG’s transition guidance indicates that for pregnancies with a first 10-week visit on or after September 1, 2026, existing E/M codes should be considered for antepartum visits when fewer than four encounters occur before 2027. It also notes that practices should check payer policy when four or more visits are involved.
That makes payer verification especially important right now.
Why Must Practices Check Each Payer’s Transition Policy?
Payers are not necessarily moving on identical dates.
For example, Highmark published guidance stating that for members expected to deliver on or after January 1, 2027, providers should begin using the new transition approach on October 1, 2026, with E/M codes and the TH modifier for applicable antepartum care.
ACOG’s broader recommendation begins no later than September 1.
That difference illustrates why practices should not assume one implementation date applies to every insurer.
For each payer, the billing team should confirm:
- Transition date
- Antepartum billing method
- TH modifier requirements
- Treatment of existing global maternity episodes
- Delivery coding beginning in 2027
- Postpartum reporting
- Claims already submitted under 2026 rules
Late 2026 is therefore a period where payer-specific maternity billing knowledge is especially important.
How Should Practices Manage Pregnancies Crossing Into 2027?
Start by identifying every active pregnancy expected to continue into 2027.
For each patient, track:
- Expected delivery date
- Current payer
- First prenatal visit
- Number of 2026 antepartum visits
- Payer transition policy
- Whether global or E/M billing is being used
- TH modifier requirements
- Provider or group responsible for care
- Any transfer-of-care history
Do not wait until delivery to determine the billing method.
By then, incorrect antepartum claims may already have created payment or coordination problems.
How Should Obstetrics Denials Be Analyzed During the Transition?
Denial reports should now separate ordinary maternity billing problems from transition-related issues.
Practices should monitor:
- Eligibility denials
- Global package denials
- Antepartum visit denials
- Transfer-of-care denials
- Duplicate claims
- TH modifier issues
- Payer transition edits
- Delivery claim problems
- Timely filing problems
If one payer begins denying antepartum claims after a particular date, the billing team should immediately review whether that payer changed its 2026 transition policy.
The objective should be to identify the policy change before dozens of additional claims are submitted incorrectly.
How Can Obstetrics Practices Reduce Eligibility and Payer-Related Denials?
A stronger maternity workflow connects coverage information with the entire pregnancy episode.
Use:
Verify → Record Coverage Dates → Track Payer Changes → Check Payer Policy → Match Services → Submit → Monitor
Practices should also maintain clear communication between:
- Front desk
- Eligibility team
- Authorization team
- Clinical staff
- Coding team
- Billing team
- Denial team
The patient should not have to discover during a denial call that the practice never updated coverage information documented months earlier.
Why Do Obstetrics Claims Move Into Aging A/R?
Obstetrics A/R often becomes complicated because the unpaid balance may represent more than one date of service.
A maternity episode can involve months of prenatal care, a delivery, postpartum services, payer changes, transfer of care, and different billing responsibilities.
When one part of that episode is structured incorrectly, the resulting balance can remain unresolved for weeks or months.
Common causes include:
- Incorrect global maternity billing
- Insurance changes during pregnancy
- Transfer-of-care confusion
- Antepartum visit-count errors
- Eligibility denials
- Authorization problems
- Duplicate billing
- Payer-specific maternity rules
- Delayed claim corrections
- Underpayments
A/R teams therefore need to understand the entire maternity episode, not just the most recent denial.
Which Maternity Claims Should Be Prioritized First?
Not every unpaid obstetric claim carries the same urgency.
A better approach prioritizes accounts based on:
- Outstanding balance
- Claim age
- Payer
- Delivery status
- Transfer-of-care history
- Denial reason
- Filing deadline
- Appeal deadline
- Previous follow-up
- Recovery potential
High-value delivery claims and balances approaching payer deadlines should receive faster attention.
The team should also identify groups of claims that share the same root cause.
For example, multiple antepartum denials from one payer may indicate a transition-policy issue rather than several unrelated coding errors.
How Should Global Maternity Denials Be Investigated?
A global maternity denial should trigger a reconstruction of the episode.
Review:
Patient → Coverage → Antepartum Visits → Provider Group → Delivery → Postpartum Care → Claim
Then answer:
- Who provided prenatal care?
- How many antepartum visits were performed?
- Did care transfer to another provider?
- Was the delivering provider in the same group?
- Who provided postpartum care?
- Did the patient’s insurance change?
- Did the payer allow global reporting?
- Were any maternity services already billed separately?
Only after those questions are answered should the claim be corrected.
Simply replacing one code with another without reviewing the episode may create another denial or duplicate claim.
How Should Eligibility-Related Denials Be Worked?
Eligibility denials require more than checking the patient’s current insurance.
The team should determine coverage on the specific date of service.
Review:
- Coverage effective date
- Termination date
- Previous insurer
- New insurer
- Medicaid or commercial coverage changes
- Secondary coverage
- Provider network status
- Maternity benefits
If insurance changed during pregnancy, the A/R team may need to separate services according to the payer responsible for each period.
The goal is to create a clear coverage timeline rather than repeatedly sending the entire maternity episode to whichever payer is active today.
How Should Transfer-of-Care Claims Be Reconciled?
Transfer of care should be treated as an episode-reconciliation problem.
Use a simple sequence:
Provider → Dates of Care → Antepartum Visits → Delivery → Postpartum Care → Payer → Claim
The billing team should identify what each practice actually provided.
For example:
- Practice A may have performed early prenatal care.
- Practice B may have assumed care later.
- Practice B may also have performed the delivery.
- Postpartum care may have remained with Practice B or moved elsewhere.
The final claims should reflect those actual responsibilities.
If more than one practice submits billing as though it provided the full maternity package, payer conflicts and duplicate denials can follow.
How Should A/R Over 90 Days Be Managed?
Maternity balances over 90 days should receive dedicated review.
Older claims may involve:
- Unresolved global-package denials
- Eligibility problems
- Transfer-of-care disputes
- Missing payer corrections
- Pending appeals
- Wrong payer submission
- Timely filing issues
- Underpayments
- Lack of follow-up
Every meaningful balance should have:
Status → Root Cause → Next Action → Owner
Claims should not sit in an aging bucket with no documented plan.
The practice should also distinguish between:
- Recoverable payer A/R
- Claims requiring appeal
- Patient responsibility
- Contractual adjustments
- Balances with limited recovery potential
This provides a more realistic view of collectible maternity revenue.
Why Should Obstetrics Practices Review Underpayments?
A maternity claim can be paid and still be financially incorrect.
Potential underpayment issues include:
- Lower-than-expected global reimbursement
- Incorrect delivery payment
- Improper contractual adjustment
- Incorrect reimbursement after transfer of care
- Payer transition errors
- Separately payable services being bundled incorrectly
That means:
Paid does not always mean paid correctly.
The billing team should compare actual reimbursement against expected payment whenever meaningful differences appear.
This becomes particularly important for delivery and maternity claims with higher balances.
How Do Payer Contract Differences Affect Maternity Revenue?
Payer differences can affect both how claims are submitted and how they are reimbursed.
Practices should understand whether a payer:
- Uses global maternity billing
- Requires individual antepartum billing
- Handles transferred care differently
- Applies specific modifiers
- Uses unique transition rules
- Reimburses certain maternity services separately
A useful reimbursement review is:
Expected Payment → Actual Payment → Adjustment → Variance → Follow-Up
If one payer consistently pays differently from expectation, the practice should determine whether the problem involves the contract, coding, payer policy, or adjudication.
Why Does Accurate Payment Posting Matter?
Payment posting is especially important in maternity billing because multiple services may be financially connected.
The team should accurately post:
- Insurance payments
- Contractual adjustments
- Denials
- Secondary balances
- Patient responsibility
- Remaining payer balances
Poor posting can hide revenue problems.
For example:
- An underpayment may be written off as contractual.
- An unresolved payer balance may be moved to the patient.
- A partial maternity payment may appear as a fully resolved account.
After every payment is posted, the next required action should be clear.
What KPIs Reveal Obstetrics Billing Problems?
A focused set of metrics provides better visibility than dozens of disconnected reports.
| KPI | What It Helps Reveal |
|---|---|
| Maternity Denial Rate | Global billing problems |
| Eligibility Denials | Coverage failures |
| Days in A/R | Payment speed |
| A/R Over 90 Days | Aging revenue exposure |
| Transfer-of-Care Denials | Split-care problems |
| Clean Claim Performance | Claim preparation quality |
| Charge Lag | Billing delays |
| Underpayments | Hidden reimbursement loss |
| Payer Variances | Contract or policy differences |
| Appeal Success | Denial recovery effectiveness |
The purpose of these metrics is not simply reporting.
Each metric should trigger action when performance worsens.
What Should an Obstetrics Billing Audit Review?
A maternity billing audit should review the entire episode of care.
That includes:
- Eligibility history
- Insurance changes
- Maternity benefits
- Authorization
- Antepartum visit counts
- Global-package eligibility
- Transfer of care
- Delivering provider
- Postpartum responsibility
- Coding
- Claims
- Denials
- Payment posting
- Underpayments
- A/R
- Payer-specific policies
- 2027 transition readiness
A useful audit should answer:
Are we billing the right maternity structure?
Are coverage changes being caught early?
Are transfers of care being split correctly?
Are claims being paid according to payer policy?
Which maternity balances are creating the greatest financial risk?
How Should Practices Prepare for the 2027 Obstetric Coding Transition?
The 2027 transition should be treated as both a coding and operational project.
Practices should first identify pregnancies expected to continue into 2027.
For those patients, track:
- Expected delivery date
- Current payer
- Payer transition policy
- Number of 2026 antepartum visits
- Whether E/M reporting is being used
- TH modifier requirements where applicable
- Provider responsibility
- Transfer-of-care history
The billing team should also review payer communications regularly because implementation timing may differ.
Internally, the practice should prepare:
- Coding workflows
- Billing-system configuration
- Staff education
- Charge capture
- Payer-specific instructions
- Denial monitoring
- Reporting
The goal is to avoid discovering the new billing structure only after claims begin denying in 2027.
How Can Obstetrics Practices Prevent the Same Problems From Returning?
The strongest approach is prevention.
Use:
Identify → Categorize → Find Root Cause → Correct Workflow → Monitor → Prevent
For example:
If eligibility denials rise, review how often maternity coverage is reverified.
If transfer-of-care claims deny, improve episode tracking between providers.
If global maternity claims fail, determine whether the practice actually provided the full qualifying package.
If one payer begins rejecting transition claims, review its current 2026-to-2027 instructions before additional claims are submitted.
The goal is not simply to improve appeal success.
It is to stop preventable claims from entering the denial queue.
Frequently Asked Questions About Obstetrics Billing Challenges
What Are the Most Common Obstetrics Billing Challenges?
Common challenges include global maternity billing, transfer of care, antepartum visit tracking, insurance changes, eligibility, payer-specific rules, authorization, denials, and aging A/R.
What Is Included in Global Maternity Billing?
Under the traditional model, qualifying global maternity codes may include routine antepartum care, delivery, and postpartum care when the required components are provided by the eligible physician or group.
When Should a Global Maternity Code Not Be Used?
A full global code may not be appropriate when care is split, the patient transfers providers, another unrelated provider performs the delivery, or payer rules require another billing method.
What Happens When a Patient Changes OB Providers?
The practices should identify the exact dates of care and determine who provided antepartum, delivery, and postpartum services.
Claims should reflect the services each provider actually performed.
What Happens When Insurance Changes During Pregnancy?
The billing team should determine which payer covered each date of service and review how the new and previous insurers require maternity services to be reported.
Why Do Global Maternity Claims Get Denied?
Common causes include incorrect global-package eligibility, transfer of care, wrong payer, duplicate billing, visit-count problems, provider mismatch, and payer-specific billing requirements.
How Should Split Maternity Care Be Billed?
Billing depends on which maternity components each provider performed and the applicable payer rules.
Practices should document antepartum visits, delivery responsibility, postpartum care, and transfer dates before determining the claim structure.
Why Should Eligibility Be Rechecked During Pregnancy?
Pregnancy spans several months, so insurance can change before delivery.
Repeated eligibility checks help identify coverage changes before claims are sent to the wrong payer.
What Is Changing With Maternity Billing in 2027?
The longstanding global obstetric coding model is transitioning to a new structure beginning January 1, 2027, with greater use of separately reported maternity services and new delivery-related codes.
Practices should follow payer-specific transition guidance for pregnancies crossing from 2026 into 2027.
What Should an Obstetrics Billing Audit Include?
An audit should review eligibility, payer changes, antepartum visits, transfer of care, global-package eligibility, delivery, postpartum services, claims, denials, payments, underpayments, A/R, and transition readiness.
Fix the Maternity Episode Before It Becomes A/R
The biggest obstetrics billing challenges cannot be solved by looking at one claim in isolation.
The billing team needs visibility across the maternity episode:
Coverage → Antepartum Care → Transfer → Delivery → Postpartum Care → Claim → Payment
When those pieces remain connected, the practice can identify who should bill, which payer is responsible, and whether global or split reporting is appropriate.
That makes it easier to prevent eligibility denials, payer conflicts, duplicate claims, and aging maternity balances.