Accurate well-child and immunization coding, fewer Medicaid and commercial denials, and faster payments for pediatric practices, managed by a dedicated billing team.
Pediatric billing isn’t adult billing with smaller patients. Preventive codes change with each age bracket, vaccines follow their own rules, and many children are covered by Medicaid, CHIP, and a commercial plan at the same time. We build your revenue cycle around these details so nothing is under-coded or left unpaid.
Unpaid pediatric claims often stall over small errors, like a missing modifier, a wrong age-based code, or a mismatched guardian record. We find them early and fix them fast.
We confirm active coverage, plan type and preventive care benefits for each child, including Medicaid and CHIP eligibility, before the visit.
When a child comes in for a checkup and leaves with an ear infection diagnosis, we correctly pair the preventive code with a problem-oriented E/M using modifier 25, so both services get paid.
Divorced or separated parents often mean two insurance plans. We apply birthday-rule and court-order logic to bill the right payer first.
From the first newborn exam to the last teen physical, we code and bill the services pediatric practices perform every day.
Accurate age-based preventive coding (99381–99395) aligned with the Bright Futures periodicity schedule and payer-specific rules.
Correct vaccine and administration coding, including 90460/90461 counseling rules and Vaccines for Children program claims.
Hospital newborn exams, discharge services, and nursery rounds coded and billed correctly the first time.
Reimbursement for ASQ, M-CHAT, PHQ-A, and ADHD assessments (96110, 96127) that practices often miss.
Confidential services, sports physicals, and mental health visits billed with attention to minor-consent and privacy rules.
Efficient E/M level selection, in-office procedures like nebulizer treatments, and strep or flu testing captured properly.
We manage the full pediatric revenue cycle: insurance verification, charge entry, coding review, claim scrubbing, payment posting, denial appeals, and patient statements. Your staff stays focused on the children in the exam room.
A single biller leaving can freeze your cash flow for weeks. Pediatric practices run on high volume and low per-visit margins, so every unbilled vaccine administration, missed screening code, or expired timely-filing window adds up quickly. Outsourcing to RCM360 replaces salary, benefits, software, and training costs with one predictable fee, and gives you a team that already knows pediatric payer rules. You get fewer denials, faster payments, and monthly reports you can actually act on.
Whether you use a pediatric-specific system or a general platform, our team logs into your existing software and handles billing directly. There is no costly migration, no double data entry, and no disruption to your clinical workflow.
Request a free, no-obligation audit. We’ll review your recent claims, flag coding gaps and denial patterns, and show you exactly where money is slipping away.
We understand state Medicaid rules, CHIP programs, and regional payer requirements, so your claims follow the right guidelines wherever you practice.
Yes. We code VFC vaccines and administration fees according to your state’s requirements, and we make sure privately purchased and state-supplied vaccines are never mixed up on claims.
Yes, when documentation supports a separately identifiable problem. We review notes and apply modifier 25 correctly to reduce denials and capture the full payment.
We verify both plans, determine primary and secondary payer status using birthday rules or custody orders, and coordinate benefits so claims are filed in the right order.
Absolutely. We know the state-specific edits, age limits, and timely-filing windows, and we appeal denials promptly with the right supporting documents.
Let us take over the paperwork so you can spend your day with patients and their families. Claim your offer today.
