Prevent
OB/GYN Denials
AI revenue cycle automation built for OB/GYN practices — specialty-aware global obstetric, preventive, and surgical coding, prior auth, and denial appeals that protect your episode and procedure revenue.
55%+
denials prevented
98%
coding accuracy
3 days
to onboard
Trusted by Industry Leaders
Why OB/GYN claims get denied
OB/GYN mixes the global obstetric package, preventive care, and surgery — each with its own billing rules. Most denied and underpaid claims trace back to a handful of recurring coding gaps.
Global obstetric package errors
The global OB package bundles routine antepartum, delivery, and postpartum care — but care that transfers, ends early, or adds complications must be carved out and billed separately. Getting the package vs. carve-out wrong loses real revenue.
Antepartum and postpartum visit counting
When a patient changes providers mid-pregnancy or has fewer visits than the global package assumes, antepartum visits must be counted and coded individually. Defaulting to the global code under- or over-bills the episode.
Preventive vs. problem-visit splits
Annual well-woman visits combined with a problem evaluation require a preventive code plus a problem E/M with modifier 25. Missing or unsupported modifier 25 means one of the two services is denied.
Ultrasound frequency and medical necessity
OB and gyn ultrasounds carry payer frequency limits and medical-necessity criteria, with technical/professional splits. Billing too often or without documentation drives recurring imaging denials.
Prior auth stalls surgery and imaging
Hysterectomy, laparoscopy, advanced imaging, and some procedures require pre-auth. Manual auth chasing delays scheduling and a missing or expired authorization denies high-value cases.
Revenue lost to under- and over-coding
Procedure and global-package notes get coded below what the documentation supports — leaving earned revenue uncollected — while overcoding quietly builds audit and takeback exposure. Catching both by hand is slow and inconsistent.
Works with EHR & PMS
What Ember automates for OB/GYN
Global package vs. carve-out, decided correctly
Ember tracks each pregnancy episode and decides when to bill the global OB package versus carving out transferred, early-ended, or complicated care — so you capture every service the package would otherwise bury.
Antepartum visit counting, automated
When a patient changes providers or has fewer visits than the global assumes, Ember counts antepartum visits and codes them individually — so split-care episodes are billed accurately instead of defaulting to the wrong global code.
Preventive and problem visits split cleanly
Ember pairs the preventive well-woman code with a problem E/M and validates modifier 25 against the documentation — so both services are paid when a single visit covers both.
Ultrasound frequency and necessity checks
Ember validates OB and gyn ultrasounds against payer frequency limits, medical-necessity criteria, and technical/professional splits before submission — preventing recurring imaging denials.
Prior authorization, handled
Ember checks eligibility, identifies which surgeries, imaging, and procedures need pre-auth, gathers documentation from the EHR, and submits through payer portals — so hysterectomy, laparoscopy, and imaging don't stall on scheduling.
Under- and over-coding analysis
Ember compares documentation against billed codes both ways — flagging undercoding that leaves earned revenue on the table and overcoding that invites audits and takebacks — so every claim matches the chart.
Outcomes OB/GYN teams can measure
55%+
of denials prevented before submission
98%
autonomous coding accuracy
50–75%
fewer staff hours on denial workflows
3 days
to onboard — value, not a year-long rollout
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
As Seen In
Frequently Asked Questions
Yes. Ember AI connects seamlessly with all major EHRs and PMS platforms — including Epic, Oracle Cerner, athenahealth, and eClinicalWorks — as well as payer portals. Our standards-based integrations automate prior authorization, eligibility verification, and claims submission, allowing you to preserve existing infrastructure while modernizing the revenue cycle.
Ember AI deployments are measured in weeks, not months. Most organizations complete pilot launch in under 30 days and scale enterprise-wide within a quarter. We provide a structured onboarding playbook, technical support, and change-management guidance so your teams achieve measurable ROI rapidly with minimal IT lift.
Yes. Ember AI is fully HIPAA and SOC 2 Type II compliant and signs Business Associate Agreements (BAAs) with all covered entities. Protected Health Information (PHI) is encrypted in transit and at rest, supported by role-based access controls, detailed audit logging, and continuous monitoring. Your organization retains complete ownership and control of its data.
Health systems, MSOs, and health plans using Ember AI typically achieve:
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
Yes. Ember's coding and scrubbing logic is specialty-aware — it understands the global obstetric package and its carve-outs, antepartum visit counting, preventive vs. problem visits, and gynecologic surgery, and validates documentation against payer medical-necessity criteria before submission.
Ember tracks each pregnancy episode and decides when to bill the global OB package versus carving out transferred, early-ended, or complicated care — and counts antepartum visits individually for split-care patients — so you capture every service the package would otherwise bury.
Yes. When a well-woman visit also addresses a problem, Ember pairs the preventive code with a problem E/M and validates modifier 25 against the documentation, so both services are paid instead of one being denied.
Yes. Ember checks eligibility, identifies which surgeries (hysterectomy, laparoscopy), imaging, and procedures require pre-auth, gathers the needed documentation from your EHR, and submits through payer portals — reducing scheduling delays and missing-auth denials.
Ember connects to your existing EHR/PMS and payer systems with standards-based integrations — no rip-and-replace. Most teams pilot in days and see measurable ROI before scaling across service lines.
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