Pediatrics Medical Billing Services
Purpose-built RCM for well & sick visits, vaccine administration, developmental screenings and telehealth—clean documentation, precise coding, faster payments.
98%+ Clean Claims
Eligibility + edits at source
30–45% Faster AR
Prioritized worklists & SLAs
24–48h Posting
ERA/EOB reconciliation
HIPAA + BAA
Secure workflows & audits
Billing & Coding Built for Pediatrics
From newborn to adolescent care, our coders interpret your documentation accurately, avoiding bundling pitfalls and capturing vaccine/admin, counseling and screenings.
- Well vs sick split with compliant −25, time/MDM capture
- Immunization inventory, NDCs, units & VFC tracking
- Screenings (developmental, vision/hearing, depression)
End-to-End Pediatrics RCM
Clinic & telehealth — eligibility through analytics.
Eligibility & Authorizations
Plan checks, PCP/IPA routing, vaccine coverage verification.
Coding & Charge Entry
Preventive E/M, problem E/M, vaccine admin & procedures.
Claims & Edits
NCCI/MUE edits, global rules, vaccine/bundle checks.
Payments & AR
24–48h posting, variance hunt, prioritized follow-up.
Denials & Appeals
Root cause, corrective coding, timely filing & escalations.
Analytics & Compliance
Dashboards, KPIs, audit trails, HIPAA controls & BAAs.
Procedures & Services We Bill Daily
- Preventive E/M by age group, immunization admin & units
- Problem-oriented E/M with −25 when significant/separate
- Screenings: vision/hearing, developmental, depression
- Rapid tests (strep/flu/COVID), nebulizer, ear lavage
- Care management, telehealth, after-hours codes
Payer Nuances We Handle
- Preventive vs problem split with correct −25 usage
- Vaccine admin & product (units, NDC, counseling)
- Age-based codes, counseling time & MDM documentation
- POS/telehealth impacts, after-hours & weekend rules
- Secondary coverage and coordination of benefits
Denial Prevention & Appeals
- Front-end edits for NCCI/MUE and vaccine bundling
- Automated eligibility & benefits with proofs on file
- Appeals by payer with timely filing tracking
- Underpayment analysis vs contracts & fee schedules
- Provider feedback loops for documentation gaps
Pediatrics RCM — FAQs
Do you handle vaccine inventory and NDCs?
Yes. We capture units, lot/expiration (from your system), and include NDC where required so claims pass payer edits the first time.
How do you prevent bundling denials?
We apply payer-specific edits for preventive vs problem visits, correct −25 usage, and vaccine product/admin pairing with accurate units.
How fast is payment posting?
Within 24–48 hours with ERA/EOB reconciliation, variance checks and prioritized AR worklists.