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Billing for Prenatal and Delivery Services

Topics included in this section:

Prenatal Care
  • Individual visits (3 or less)
  • Prenatal services only (no associated delivery)
  • Prenatal with delivery and postpartum (7 or more prenatal visits)
  • High-risk pregnancies
  • Illness during prenatal period

Delivery & Postpartum Care
  • Delivery only (no prenatal or postpartum care)
  • Delivery and postpartum care (no prenatal)
  • Postpartum care only (no associated delivery)
  • Cesarean section
  • Multiple birth deliveries
  • Multiple births by Cesarean section

When Additional Information May Be Needed
Priority Health will return claims for additional information in some cases. Examples include:
  • Member became effective with Priority Health during the pregnancy: Another insurance plan or the member would be responsible for the portion of the payment for services
  • Member loses coverage during pregnancy
  • Member changes from a Priority Health self-funded plan to a Priority Health fully funded plan, or vice versa (payor changes from the employer to Priority Health or vice versa)
Last modified 06/26/06