Malpractice history unexplained
Obstetric claims are common and often without merit, but an application that lists them without explanation goes to committee with questions. A clear narrative and resolution documents move it through.
Specialty credentialing program
OB/GYN Credentialing Services
OB/GYN credentialing turns on hospital delivery privileges, a malpractice history that payers examine closely, and Medicaid, which pays for a large share of births. We credential obstetricians, gynecologists, certified nurse midwives and women's health NPs with every payer and facility.
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
- Delivery privileges at each hospital
- Malpractice narrative prepared in advance
- Medicaid maternity enrollment
- CNMs and WHNPs credentialed individually
- Subspecialty designations where relevant
Obstetrics has the highest malpractice exposure of any specialty, and payer credentialing committees review every claim and settlement in detail. Delivery privileges at one or more hospitals are required for obstetric practice and requested by most payers. Medicaid covers roughly four in ten births nationally, so state enrollment and MCO credentialing are essential, and pregnancy-related Medicaid coverage has its own eligibility categories.
ClainetRCM prepares OB/GYN files with the malpractice explanations committees expect, coordinates delivery and surgical privileges, and enrolls the practice with Medicaid, MCOs and commercial plans so prenatal, delivery and gynecologic services are all payable.
Where this usually goes wrong
Privileges at multiple hospitals
Obstetricians often deliver at more than one hospital, each with its own credentialing and reappointment cycle.
Midwives credentialed inconsistently
Certified nurse midwives are credentialed by Medicare and most payers, but some plans and Medicaid programs have specific requirements for supervision or collaboration.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- Complete file with board certification, delivery and surgical case logs and malpractice history narrative
- Hospital delivery and surgical privileges at each facility, with reappointment tracking
- Medicare enrollment for gynecologic and Medicare-eligible obstetric services
- State Medicaid and MCO enrollment including pregnancy-related coverage programs
- Commercial payer credentialing with OB/GYN and subspecialty designations
- Certified nurse midwife and women's health NP credentialing linked to the group
OB/GYN credentialing components
Hospital privileges Obstetric and gynecologic surgical privileges at each hospital where the practice delivers. See hospital privileging.
Malpractice review NPDB verification and committee review; explanations prepared in advance. See primary source verification.
Medicaid State enrollment and MCO credentialing for maternity coverage. See Medicaid enrollment.
Midwives and NPs CNM and WHNP credentialing with population focus taxonomy. See NP credentialing.
Subspecialties Maternal-fetal medicine, reproductive endocrinology and urogynecology with additional designations and privileges.
Billing Our OB/GYN billing program handles global maternity packages and gynecologic procedures.
How the work runs
The sequence is the same for every payer and provider type; what changes is which documents and portals each step touches.
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
After enrollment
OB/GYN billing
Global maternity and gynecologic procedures. Once your providers are payable, the same team keeps the claims moving.
Frequently asked questions
Payer credentialing 90 to 150 days and hospital privileges 90 to 180 days per facility. Files with malpractice history take the same time when the explanations are prepared up front, and much longer when they are not.
Rarely on its own. Payers expect obstetricians to have claims history. What matters is complete disclosure, a clear explanation and documentation of resolution. We prepare that narrative with you before submission.
Medicare enrolls CNMs directly and pays at the full physician fee schedule. Most commercial and Medicaid plans credential CNMs individually, with state-specific collaboration requirements in some cases.
Yes. Pregnancy-related Medicaid coverage runs through the same enrollment but may involve specific programs and presumptive eligibility arrangements by state. We enroll the practice with all applicable programs and MCOs.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.