Pediatric Medical Billing Specialists
Pediatric billing requires specialized knowledge of age-specific codes, immunization programs, and the unique insurance coordination challenges that children's healthcare presents.
Pediatric Billing Challenges
Age-Specific Code Requirements
Pediatric billing requires precise age-based code selection. Using adult preventive codes for children, missing age-specific immunization schedules, or incorrect well-child visit codes (99381-99394) based on patient age creates systematic billing errors and reduced reimbursement.
VFC Program Billing Complexities
Vaccines for Children program billing involves federal tracking requirements and specific documentation. Missing VFC eligibility verification, incorrect administration billing, or inadequate vaccine lot tracking leads to audit issues and potential recoupment demands from federal programs.
Parent/Guardian Insurance Coordination
Pediatric practices often deal with multiple insurance plans from divorced parents or complex family situations. Incorrect primary/secondary coordination, missing authorization from custodial parents, or billing inactive insurance plans creates payment delays and collection complications.
EPSDT Service Documentation
Early Periodic Screening, Diagnostic and Treatment services have enhanced Medicaid reimbursement but require specific documentation. Missing developmental screening codes, inadequate referral documentation, or incomplete EPSDT forms result in lost revenue opportunities and compliance issues.
Our Pediatric Billing Approach
- We maintain expertise in age-specific pediatric coding requirements, ensuring accurate well-child visit billing and proper immunization administration coding that aligns with CDC schedules and insurance policies.
- Our team manages VFC program requirements systematically, including eligibility verification, vaccine inventory tracking, and the specialized billing protocols required for federally supplied vaccines.
- We implement sophisticated insurance coordination workflows for pediatric practices, managing complex family insurance situations and ensuring proper primary/secondary billing to maximize collections.
- Our pediatric billing specialists understand EPSDT requirements and Medicaid enhanced services, identifying revenue opportunities while maintaining compliance with state and federal pediatric care programs.
Pediatric Practice Performance
Enhance Your Pediatric Practice Revenue
Let our pediatric billing experts handle your complex children's healthcare billing while you focus on providing excellent pediatric care.