Credentialing is required for insurance reimbursement and is the process of collecting information to confirm the doula meets requirements set by the health plan’s contract. 

Requirements include ::

1. Current birth doula certification (most certifications accepted)
2. Level 2 Background Screen
3. Liability Insurance
4. CPR/First Aid Training
5. HIPAA Training
6. Application form including location of services. Using an automated credentialing process, NDN collects required information and sets reminders and due dates for when items need to be renewed, so doulas’ credentials remain current year after year. After the information is collected and verified, the doula meets with NDN to discuss any questions and begin onboarding and software training.

No. There is no annual fee or fee to join. There are costs related to joining NDN such as doula certification, background screening, CPR / First Aid certification, liability insurance, and owning an Apple device for secure charting. If these costs or technology requirements create a barrier to joining NDN, please email hello@nationaldoula.com to discuss options for support.

No, Health plans set their own terms and there are SMMC health plans in Florida providing birth doula services that are not contracted with a network. Unfortunately, NDN does not have information on how reimbursement is processed by those plans. NDN works with the Agency for Healthcare Administration and other community partners to support pathways for individual doula reimbursement. This project is ongoing, to receive updates, sign up for NDN’s newsletter.

Doulas are independent contractors with NDN. After completing care with a client, NDN reviews and verifies charting documentation and submits the claim for reimbursement.  NDN monitors the claim’s progress from beginning to end and follows up with the health plan to address claim rejections and ensure doula payments are processed. Each health plan sets their own approved billing codes and reimbursement rates for the type of care provided. As independent contractors, all doulas are paid by direct deposit and receive an annual 1099 form from NDN. The direct deposit occurs after NDN receives payment from the health plan. As this is a new benefit, NDN works directly with the health plans to address concerns and improve the timing of the payments. Payment is typically received within 2-4 weeks after the claim has been submitted. At this time, NDN has a 100% reimbursement success rate. 

Can I take a retainer until payment comes after the birth?

No. As a Medicaid insurance benefit, no money can be exchanged between the doula and client for birth doula services. If you provide non-birth doula related services (e.g. placenta encapsulation), you can have a separate contract and fee, as long as birth doula services are not a part of the contract.

NDN negotiates directly with health plans to set reimbursement rates at a market rate for birth doula services and then negotiates an administrative fee, in addition to the doula’s rate, to provide NDN’s support services. NDN’s contract with the health plan improves members’ access to doula care and includes a full list of additional support services, which include, but are not limited to: case management, HIPAA compliant EHR software, doula credentialing, community referrals, data collection, billing and claims processing.

There are many different ways clients are referred to NDN: 

• Doulas can refer their own clients by completing an online referral form. NDN receives the referral, verifies benefit eligibility with the health plan, contacts the client to confirm health plan eligibility and communicates with the doula to begin care. Any client referred to NDN by a doula, is that doula’s client. NDN provides ongoing support and resources, if needed, and monitors insurance eligibility throughout the client’s pregnancy, alerting the doula about any changes that will impact reimbursement. 
• Clients can submit their own referral to request doula support by completing an online form. After confirming insurance eligibility and communicating with the client, as described above, the client chooses the doula they would like to work with in their community. NDN then confirms the doula’s interest and availability to support, if the doula is available, NDN makes an introduction to the client and sets up the client’s record in Mobile Doula.  NDN provides ongoing support for the client and doula, if needed, by monitoring insurance eligibility throughout the client’s pregnancy, alerting the doula about any changes that will impact reimbursement. 
• Health plan Case Management Teams discuss doula service options with health plan members and make direct referrals to NDN. NDN verifies benefits upon receipt of the referral and the client chooses the doula they would like to work with in their community. following the same process outlined above. 
• Community Partners supporting families in their communities refer clients to doula services via fax, email or online referral. NDN verifies benefits upon receipt of the referral and the client chooses the doula they would like to work with in their community. following the same process outlined above
• Any other provider or individual can refer clients to doula services and submits a referral using a paper or online form. NDN verifies benefits upon receipt of the referral and the client chooses the doula they would like to work with in their community. following the same process outlined above

Charting and documentation of client encounters is a requirement for insurance reimbursement. NDN provides doulas with access to Mobile Doula, a HIPAA compliant EHR software used to chart all client encounters and to process claims, at no cost to the doula. Charting is a new process for many doulas and NDN provides ongoing support and technical assistance, as needed. Most doulas report that Mobile Doula is easy to use. NDN continues to make enhancements based on doula feedback – there are limitations to using Mobile Doula is that it requires an Apple device (iPhone, iPad, Mac) and we remain open to identifying alternate solutions. 

The charting and documentation requirements are to create a basic  narrative of client encounters including prenatal visits, labor and birth support, and postpartum care. For labor / birth support, doulas are asked to chart hourly or whenever a key event occurs. If you have questions about charting or documentation requirements, email hello@nationaldoula.com. 

NDN supports the knowledge, autonomy and expertise of doulas serving their communities. The doula’s private business and management of the business is independent from NDN. NDN does not tell doulas how to provide care to families. If and when complex client situations arise and doulas want additional information or support to meet a client’s needs, NDN is available to help with navigating health plan benefits, a change in providers, referrals for mental health care or other community resources. Doulas hold the primary relationship with their clients and NDN provides an added layer of administrative support for doulas. The NDN model follows a few simple Do’s and Don’ts, listed in the graphic below and provides a framework for reimbursement which includes a number of client visits outlined by the health plans, but not the what or how visits are completed. Doulas are not required to accept clients, support for a set number of clients per month or per year or provide transportation.

There are many ways NDN provides ongoing and continuous support for doulas, including, but not limited to: 

• advocating for doula reimbursement rates at a market rate that is well above the national average for doula reimbursement. 
• advocating for the removal of specific certification and credentialing requirements that create barriers for doulas to receive reimbursement for their services. NDN advocates for most certifications to be included and eligible for reimbursement. 
• alleviating the administrative burden for doulas filing claims for reimbursement by processing and managing paperwork, monitoring client insurance eligibility throughout pregnancy and postpartum, and spending hours and hours (and hours) on the phone with health plans to troubleshoot why payments are not being processed, so doulas can spend those valuable hours focused on supporting their clients and their communities. 
• supporting doulas with setting up NPIs and advocating for doulas to have clear pathways to receive individual Medicaid IDs
• providing financial security through direct deposit payments and if / when reimbursement payments are recouped by the health plans, NDN takes the hit, not the doulas’ bank account. 
• access to ongoing case management resources, a growing network of community referrals and support for doulas when they need additional resources for a client. 
• access to ongoing learning opportunities for skill development through our trusted network of community experts and providers.  
• paid access to HIPAA compliant EHR software for charting and documentation to maintain compliance with reimbursement requirements. 
• day to day support from NDN staff, as needed, for client and billing management.
• collaborating with community partners to increase utilization and awareness of insurance covered birth doula service benefits in their communities and increasing direct referrals to doulas and their businesses.
• access to training and development opportunities for new Doula’s to be trained in their communities. 
• access to a supportive network of credentialed doulas available for back-up support, networking and community resources. 
• documentation support through essential personnel letters, credential certificates, outreach and other tools to increase hospital access and staying informed about restrictions and requirements to increase patient access to their insurance covered benefits.
• providing prepared marketing flyers and information to advertise services within provider offices and facilities. 
• meeting with state level leaders and policy makers to advocate for the expansion of doula service options at the health plan level and inviting interested doulas to participate.

One of NDN’s core values is collaboration. NDN works to align its efforts alongside the existing work of community leaders and organizations.  Some of our key partners include: Healthy Start Coalitions, March of Dimes, health departments, diaper banks, colleges and universities, local and national Doula training organizations, the Agency for Healthcare Administration, health plans, birth centers, community hospitals, case managers, Healthy Families, Race for Equity and numerous other local and national organizations committed to improving access to insurance-covered doula care.

NDN was founded in 2019 on the core belief that every birthing person deserves access to affordable, safe and collaborative perinatal care and doulas are essential members of the maternal care team. NDN began as an idea and evolved from Elizabeth and Kara’s careers and experience as birth and postpartum doulas, mothers, community health workers, advocates, a birth center owner (Elizabeth) and a deep commitment to creating meaningful provider, client, and community connections. Through the work and collaboration of doulas (so many fantastic, powerful, committed, conscientious, community centered doulas), community partners, and health plans, NDN is a reality. This journey was started by two, but is the result of hard work, dedication and community ethos of so many. We are grateful for everyone that has supported, challenged and encouraged us along the way.