Specialized Billing Expertise

Pediatric Medicine & Child Wellness Billing Solutions

Pediatric billing is characterized by high volume, Medicaid requirements, developmental screenings, immunizations, and EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) programs.

Clean Claim Rate
99.3%
AR Cycle Average
20 Days
Denial Rate
1.0%
Audit Recovery
99.0%
Pediatric Medicine & Child Wellness Billing Solutions
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Claims Scrubbing Lifecycle
Active Flow
1
VFC Vaccine Split
2
Screening Code Bundles
3
Medicaid EPSDT compliance
Target: 98%+ Clean Claim Rate99.3% Live Approval
1

VFC Vaccine Split

Splitting vaccines from the Vaccines For Children program from private stock.

2

Screening Code Bundles

Adding developmental and behavioral screenings separately from standard wellness checkups.

3

Medicaid EPSDT compliance

Formatting electronic files to match state-specific Medicaid guidelines.

Claims_Audit.log
SECURE HIPAA
LINE 01 // INIT CLAIMS_AUDIT_SEQUENCE...
LINE 02 // SPECIALTY_SLUG = "pediatrics-billing"
LINE 03 //CPT 99392SCRUBBED_OK
LINE 04 // AUTO-ROUTING TO CLEARINGHOUSE...
STATUS: ACTIVE RUN20 Days Average AR

Guardian Eligibility

Verify active parent/guardian coverage and newborn sign-ups.

Well-Child Scrubbing

Track vaccine lots and code administrations separately.

State Registry Check

Report vaccine codes according to VFC requirements.

Copay Auditing

Prevent unlawful copay charges on ACA-mandated preventive wellness checks.

Modifier Audit Performance99.0% Recovery
First-Pass Clean Claim Rate99.3%
Denial Rate Prevention99.0%
Clean Claim Target: 98%HIPAA Audits Reprocessed
CPT 99392Well-child care, age 1-4 years
CPT 96110Developmental screening with scoring
CPT 90686Influenza vaccine, preservative-free
Modifier 25Separately billable checkup and sickness code

Denial Recovery Performance

96.5% Recovery

We resolve pediatric denials for 'duplicate wellness checks' by submitting birth certificates and clinical documentation.

100% HIPAA compliant claims reprocessing

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CLIENT TESTIMONIAL

“Success Seekers RCM has completely transformed our Pediatrics billing. Our collections are up 28% and billing stress is gone.”

— U.S. Clinical Director, Pediatrics Specialist Group