Fertility Benefit Manager Billing Guide
Fertility benefit managers (FBMs) like Progyny, WINFertility, Carrot, Maven, and Kindbody sit between the employer and the fertility practice — with their own authorization processes, billing rules, and network requirements. Billing them incorrectly is one of the most common causes of denied ART claims.
FBM Quick Comparison
| Factor | Progyny | WINFertility | Carrot Fertility | Maven Clinic | Kindbody |
|---|---|---|---|---|---|
| Billing model | Bundled Smart Cycle | Fee-for-service | Member reimbursement | Navigation + medical plan | Employer direct contract |
| Bill directly? | Yes — bill Progyny | Yes — bill WINFertility | No — patient pays first | No — bill medical insurer | Yes — via Kindbody portal |
| Prior auth required? | Yes — Smart Cycle auth | Yes — case manager approval | No pre-auth for most | Varies by employer | Yes — per contract |
| Timely filing | 90 days | 90–180 days | N/A (member reimburse) | Per medical plan | 90 days |
| Network required? | Yes — contracted only | Yes — WIN network | Preferred (Carrot network) | No (any provider) | Yes — partner network |
Progyny Fertility Billing
Smart Cycle (bundled)400+ large employers, 6M+ covered lives
Key billing fact: Progyny uses a bundled "Smart Cycle" model — all services within a cycle are billed together under one authorization. Each Smart Cycle covers a defined set of services including retrieval, lab work, and transfer.
Auth & Filing
Top Denial Reasons
- ✗Services billed outside the Smart Cycle bundle
- ✗Services billed to the medical insurer instead of Progyny
- ✗Timely filing missed (90-day window)
- ✗Non-Progyny-contracted lab or pharmacy used
Billing Tips
Detailed CPT codes, Smart Cycle breakdown, and claim examples.
EasyRCM handles Progyny billing for fertility practices nationwide — auth submissions, claim routing, and denial appeals.
Get a Free AuditWINFertility Fertility Billing
Fee-for-service with case management200+ employers, large self-funded groups
Key billing fact: WINFertility acts as a fertility case management layer on top of the employer's existing health plan. Members receive a dedicated nurse case manager. All fertility services require WINFertility authorization, even if the procedure would be covered by the underlying medical plan.
Auth & Filing
Top Denial Reasons
- ✗Authorization obtained from medical insurer only — WINFertility auth also required
- ✗IVF cycle started before WINFertility case manager approves the clinical plan
- ✗Out-of-WINFertility-network provider used
- ✗Non-covered add-ons billed within covered cycle (e.g., elective PGT-A)
Billing Tips
EasyRCM handles WINFertility billing for fertility practices nationwide — auth submissions, claim routing, and denial appeals.
Get a Free AuditCarrot Fertility Fertility Billing
Reimbursement wallet (member pays, employer reimburses)900+ employers globally, growing rapidly
Key billing fact: Carrot Fertility is a reimbursement-based benefit, not a direct payer. The patient pays the fertility practice directly, then submits receipts to Carrot for reimbursement from their employer-funded "Carrot account." Practices are NOT directly reimbursed by Carrot unless they are in the Carrot provider network.
Auth & Filing
Top Denial Reasons
- ✗Patient unaware they must pay out-of-pocket first (collection risk)
- ✗Services not covered by the patient's specific Carrot benefit (employer-defined)
- ✗In-network Carrot clinic benefits vs. out-of-network reimbursement confusion
Billing Tips
EasyRCM handles Carrot Fertility billing for fertility practices nationwide — auth submissions, claim routing, and denial appeals.
Get a Free AuditMaven Clinic Fertility Billing
Digital-first with care navigation + benefit management500+ employers including Fortune 500
Key billing fact: Maven Clinic combines virtual care navigation with employer fertility benefit management. Maven assigns care navigators who guide members through fertility treatment choices. Billing flows through the underlying medical insurer in most cases, with Maven adding a navigation and benefit coordination layer.
Auth & Filing
Top Denial Reasons
- ✗Billing the wrong entity — Maven does not directly pay claims in most implementations
- ✗Services not on the Maven-approved care pathway for the patient
- ✗Failure to coordinate with the Maven care navigator before major procedures
Billing Tips
EasyRCM handles Maven Clinic billing for fertility practices nationwide — auth submissions, claim routing, and denial appeals.
Get a Free AuditKindbody Fertility Billing
Employer direct contract (Kindbody-owned clinics + partner network)175+ employers, own clinic network in major metros
Key billing fact: Kindbody primarily operates its own fertility clinics under direct employer contracts. Independent practices can become Kindbody partner network providers, allowing them to serve Kindbody-covered employees. Partner network billing is processed through Kindbody's employer contracts, not the standard insurance channel.
Auth & Filing
Top Denial Reasons
- ✗Non-Kindbody provider billing employer without Kindbody network agreement
- ✗Services outside the Kindbody employer contract scope
- ✗Billing the medical insurer instead of through the Kindbody employer contract
Billing Tips
EasyRCM handles Kindbody billing for fertility practices nationwide — auth submissions, claim routing, and denial appeals.
Get a Free AuditFertility Benefit Manager FAQ
What is a fertility benefit manager (FBM)?
A fertility benefit manager (FBM) is a company hired by employers to manage their employees' fertility benefits separately from the main health insurance plan. FBMs like Progyny, WINFertility, Carrot Fertility, Maven Clinic, and Kindbody administer fertility coverage, prior authorizations, and network access. Billing an FBM requires different processes than billing the standard medical insurer.
How do I know if a patient has a fertility benefit manager?
FBM coverage is rarely visible on the insurance card. To check: (1) Ask the patient directly if their employer offers a fertility benefit through a company like Progyny or Carrot. (2) Call the primary insurer's member services and ask if the fertility benefit is managed by a third party. (3) Check the patient's explanation of benefits or HR benefits portal. EasyRCM performs this verification for every new fertility patient.
Do I need to be in-network with a fertility benefit manager to serve their members?
For Progyny and WINFertility, yes — you must be a contracted network provider to bill them directly. Carrot Fertility allows any provider but members pay out-of-pocket and seek reimbursement (reduced reimbursement for out-of-network). Kindbody requires partner network status for direct billing. Maven Clinic members can generally use any provider and bill the underlying medical insurer.
What happens if I bill the wrong entity for a Progyny patient?
If you bill the medical insurer for services that should go through Progyny, both claims will be denied or one will be reversed. Progyny-covered ART services (IVF retrieval, embryology, FET) must be billed to Progyny under the Smart Cycle bundle. Non-ART services (prenatal care, OB complications) still go through the medical insurer. Always verify which entity covers which services for Progyny patients.
EasyRCM handles Progyny, WINFertility, Carrot, Maven, and Kindbody billing for fertility practices. Get a free audit to find what's being missed.