Billing Claims

Send your billing details so Maggie can file or finish your claim.

Midwives can submit billing info for a client. Clients can submit their own info too.

Use this form after care is done. Midwives can submit billing info for a client. Clients can submit their own info too.

The form goes straight to Maggie at maggie@napiermidwiferybilling.com.

Instructions

Fill out every field as completely as you can.
Leave a field blank only if it does not apply to your birth.
The more complete the form, the faster I can process your claim.

Submit Your Billing Information

Provider & Member

Midwife's name

Member's name

Member's date of birth

Last menstrual cycle

Member's address

Insurance

Name of Insurance (Ignore if a VOB is on file)

Member ID

Group number

Policy holder's name

Policy holder's date of birth

Delivery Details

Delivery date

Did the member have a home birth, hospital birth, or birth center birth?

List capillary draw dates

List venipuncture draw dates

Was aquatherapy used for labor management?

Was nitrous oxide used for labor management?

IV therapy — if yes, how many minutes?

Did the member experience a postpartum complication? If so, what complication?

Rhogam injection dates with NDC number

Was a foley catheter utilized?

Did the member require oxygen therapy?

If birth center admission: admission date/time

If birth center admission: discharge date/time

Newborn Information

Name of newborn

Newborn gender

Time of birth

Was a birth assistant present?

If vitamin K was administered IM, what is the NDC?

Did newborn require resuscitation?

Did newborn require oxygen therapy?

Newborn home visit dates

Newborn office visit dates

Metabolic Screen Dates

Bilirubin test dates (if applicable)

Visits & Transfers

Please list individual prenatal visit dates

Please list individual postpartum visit dates

If mother transferred to hospital during labor: date and hours spent with member until transfer

If mother transferred to hospital during labor: date and hours spent with member at hospital

Did the member receive massage therapy in house? If so, please list the dates.

NST dates (if applicable)

Telehealth visits

Billing Totals & Oversight

What is the total amount billed to the patient for maternity care?

What is the total amount paid by the patient as of today's date?

Date of Physician Initial Consult (for oversight fee and date of chart review, if applicable)

Name of individual submitting the form

Your information is sent directly to Maggie.