OB/GYN Credentialing and Enrollment

Obstetrics and gynecology practices combine office care, surgery and deliveries. That mix means the credentialing file includes hospital privileges, often at more than one facility, alongside the usual payer applications. Many practices also employ certified nurse midwives or nurse practitioners, who need their own enrollments.

Below is what payers and hospitals look at for OB/GYNs, where files stall, and how Maverick helps.

Board certification

OB/GYNs are certified by the American Board of Obstetrics and Gynecology (ABOG) or the American Osteopathic Board of Obstetrics and Gynecology (AOBOG). Subspecialists, such as maternal-fetal medicine or reproductive endocrinology specialists, carry additional certification. Payers and hospitals verify status with the board.

Hospital and labor and delivery privileges

Deliveries and gynecologic surgery require privileges at each facility where you practice. Hospitals run their own medical staff processes, often with specific case logs and proctoring for new physicians. Most payers check that privileges are in place, so privileges and payer enrollment need to move together rather than one after the other.

Medicaid and pregnancy coverage

Medicaid covers a substantial share of births in many states, so obstetric practices usually need state Medicaid enrollment and credentialing with the Medicaid managed care plans in their area. In Texas, that means TMHP and then each plan. Our Texas Medicaid enrollment guide explains the state process.

Midwives and advanced practice clinicians

Certified nurse midwives, nurse practitioners and physician assistants each need their own payer and Medicare enrollments. Medicare recognizes certified nurse midwives as a provider type on the CMS-855I. Groups that add midwives without enrolling them separately lose the ability to bill for their work. Our CMS-855 form guide covers the forms.

Where files usually get stuck

None of these are unusual. They are the small inconsistencies that pile up when a practice is busy seeing patients:

• Payer applications submitted before hospital privileges are confirmed
• Midwives or nurse practitioners providing care before their own enrollments exist
• Medicaid plans credentialing the group at one hospital or location only
• Malpractice coverage details that do not match what the hospital and payer each have on file
• Privileges at a second facility lapsing at reappointment

What to send us

We send a tailored checklist at kickoff, but most ob/gyn files start with the same core documents. Having them ready is the single biggest thing you can do to keep your file moving:

• State license(s) for every state where you see patients
• Board certificate or documentation of board eligibility
• Medical school, residency and fellowship details
• DEA and any state controlled substance registrations
• Current malpractice certificate and claims history
• Hospital or surgery center privileges, or your admitting arrangement
• Practice locations, tax ID details and banking information for payments
• CAQH and PECOS logins, or permission for us to set them up

Texas and multi-state practices

We are based in Austin and work Texas files every day, from TMHP and Texas Medicaid managed care to the commercial plans that dominate each metro area. We also work with practices in all 50 states. If your clinicians are licensed in more than one state, or you are expanding, we map the licensing, Medicare and payer work for each state before anything is filed so nothing is missed.

How Maverick helps

We start with a records check: licenses, board status, NPPES, CAQH, existing Medicare and Medicaid enrollments, and any privileges already in place. Then we build the payer list that fits your market, prepare every application, and submit once your file is complete. We follow up with payers, facilities and the Medicare contractor on a set schedule, answer their requests for more information and keep you updated until each file closes. Afterward, re-credentialing, revalidation and CAQH re-attestation go on our calendar instead of yours.

What we will not do is promise a payer's approval date. Payers and agencies set their own processing times. What we control is a complete file, fast responses and steady follow-up.

Which package fits

Maverick Launch (Solo or Group) fits new OB/GYN practices and physicians joining a group, with payer enrollment coordinated alongside hospital privileges. Autopilot keeps reappointments, re-credentialing, Medicaid revalidation and CAQH on schedule. Established practices can add Rate Check to review existing commercial contracts.

Not sure which applies? A short call is enough to scope it, and you get a written quote before anything is committed.