U.S.-based pediatric billing experts ensuring accurate CPT coding, 98% clean claim rate, and full Medicaid compliance for private practices and clinics nationwide.
Request a Free RCM AuditExpert use of CPT 99381–99394 for well-child visits and HCPCS 90471/90685 for vaccines with correct administration and component billing.
Full adherence to state-specific Medicaid rules, EPSDT screening requirements, and vaccine coverage policies to prevent denials.
We bill for every administered dose and recover revenue for unused vials using modifiers JW/JZ.
Real-time Medicaid/CHIP eligibility checks before visits to prevent claim rejections and patient billing surprises.
Monthly reports on missed well-visit codes, underbilled vaccines, and payer underpayments to recover lost revenue.
Work with coders who understand pediatric workflows, developmental screenings, and vaccine bundling rules.
Pediatric billing requires precision in well-visit coding, vaccine tracking, and Medicaid compliance — errors lead to automatic denials.
Using E/M codes instead of preventive CPT 99381–99394 triggers 50–100% revenue loss for routine visits.
Failure to bill for vaccine components or administration leads to $20–$150 lost per immunization.
Patients not verified for current Medicaid coverage face claim denials and delayed reimbursements.
Charge capture delays between nurse documentation and billing result in missed or under-coded services.
A seamless, 5-step workflow designed for private pediatric practices and clinics.
Verify Medicaid/CHIP status and vaccine coverage before the visit.
Assign accurate CPT and HCPCS codes with correct modifiers based on clinical documentation.
Submit clean claims with NCCI edit validation and payer-specific rule checks.
Appeal denials within 48 hours for eligibility, coding, or documentation issues.
Deliver monthly KPIs: missed well-visits, underbilled vaccines, net collection %, and payer performance.
Clean Claim Rate
Fewer Claim Denials
Recovered Vaccine Revenue
Based on 35 pediatric clients served in 2024. Results may vary.
Learn how missed well-visit codes, underbilled vaccines, and Medicaid eligibility errors cost practices thousands monthly.
Explore More →Discover how to bill for vaccine components, administration, and wastage to recover 100% of eligible reimbursement.
Read Guide →The average pediatric practice loses 25–35% of revenue to preventable denials, missed well-visits, and vaccine underbilling.