Specialty billing
Pediatric Medical Billing Built for High Volume and Thin Margins
Well-child visits, immunisation administration and a Medicaid-heavy payer mix that punishes small errors.
The challenge
What makes pediatric billing different
Pediatrics runs on volume and preventive care, which means the margin on any single encounter is slim and the cost of reworking it is disproportionately high. A practice seeing forty children a day cannot absorb a five percent denial rate the way a procedural specialty can.
The payer mix compounds it. Medicaid and CHIP make up a large share of pediatric revenue in most markets, each with their own well-child periodicity schedules, prior authorization quirks and lower tolerance for documentation gaps.
Why us
Why pediatric practices choose us
Specialty billing is not a marketing label for us. Coders and A/R staff are assigned by specialty, so the person on your account reads notes like yours every day.
Get a free assessment- Immunisation administration coded alongside every vaccine product, without exception
- Well-child periodicity tracked against each payer schedule rather than a single generic calendar
- Vaccines for Children inventory kept distinct from privately purchased stock
- Sick visits alongside well visits billed correctly rather than surrendered
Scope of work
What we handle for pediatric practices
The work below is specific to this specialty, not a generic billing checklist with the name swapped out.
Well-child and EPSDT visits
Preventive visits coded to age band and payer periodicity, including state EPSDT requirements.
Vaccine and administration coding
Product and administration coded together, with counselling components captured where documented.
Vaccines for Children program
State-supplied VFC doses billed distinctly from private stock so inventory and claims reconcile.
Same-day sick and well visits
Both services captured when a preventive visit uncovers a problem requiring separate work.
Newborn and hospital care
Newborn attendance, initial care and hospital day coding coordinated with the outpatient record.
Developmental and behavioral screening
Screening and assessment instruments billed when administered and documented as required.
The Right Way difference
What we watch on pediatric claims
These are the details that separate a paid claim from an appealed one in pediatric. They are checked on every claim, not sampled.
- 01 Age-band accuracy on preventive codes, where a birthday can shift the correct code mid-cycle
- 02 Correct modifier use when a problem-oriented visit is provided alongside a preventive one
- 03 Counselling-based administration codes where the physician counselling is documented
- 04 State Medicaid periodicity schedules, which differ from commercial well-child intervals
- 05 Newborn coverage under the mother policy in the first weeks, which is a frequent denial source
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Years running revenue cycles for physician practices
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Providers billed for across every specialty we serve
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First-pass clean claim rate
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Median days in accounts receivable
Questions
Pediatrics billing questions
What practices in this specialty ask us most often before making a change.
Ask us something elseUsually yes. The service is billable when the problem addressed is significant, separately identifiable and documented as its own assessment and plan. The fix is part documentation coaching and part correct modifier use.
Yes. VFC doses are billed with the administration component and the appropriate program indicators, kept separate from privately purchased inventory so your stock reconciliation stays clean.
With a root-cause breakdown of the last six months. Pediatric Medicaid denials cluster tightly around eligibility, periodicity and administration coding, and knowing which cluster you are in tells us what to fix first.
How it works
Getting started takes about a month
The same four steps whichever specialty you are in. No system migration and no gap in your cash flow.
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01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
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02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
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03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
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04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Let us look at your pediatric claims
Send us a sample and we will tell you specifically what is being coded, denied or under-paid — and what it is worth to fix. Free, and yours to keep.