Pediatric Billing Services
Specialized pediatric billing that protects revenue while letting your clinicians focus on kids fewer denials, faster payments, and Medicaid-savvy workflows.
You love caring for kids. We love making sure you get paid for that care. Pediatric billing is uniquely different from adult medicine more well-child visits, faster visit turnover, vaccines, frequent insurance changes (including Medicaid/CHIP), sibling visits, and a higher volume of preventive services. At Sirius Solutions Global we specialize in pediatric billing so your front desk can focus on families and clinicians can focus on care while we handle the complex rules that govern pediatric reimbursement.
Our Comprehensive Pediatric Billing Services
We tailor billing programs for solo pediatricians, group practices, and pediatric hospital clinics. Here’s the deep list include what you want on the page and add CMS links where needed.
Pre-visit & Front Desk Support
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Real-time insurance eligibility & benefit verification at every visit (co-pay, deductible, vaccine coverage, prior auth needs).
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Check-in scripts for families to capture accurate insurance info and consent for vaccine billing.
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Sibling appointment grouping and family-billing efficiency best practices.
Charge Capture & Pediatric Coding
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Accurate capture of preventive visit CPTs (99381–99397 and age variants), E/M coding, vaccine administration, and procedure codes.
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ICD-10 mapping for age-specific diagnoses and congenital conditions.
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Modifier management for split/shared visits, vaccine administration, and multiple services on the same day.
Vaccine Billing & Inventory Reconciliation
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VFC vs commercial billing workflow separation.
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Vaccine administration CPTs and NDC reconciliation to prevent lost revenue and ensure inventory accountability.
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Automated flags for vaccine eligibility programs and grant-funded supplies.
Claim Scrubbing, Submission & Monitoring
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Pediatric-aware claim scrubs that check diagnosis-to-CPT compatibility (e.g., well-visit vs problem visit) and age restrictions.
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Electronic submission, daily claim tracking, and automated resubmission workflows for clean claims.
Denial Management & Appeals
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Root-cause denial analytics (e.g., preventive vs problem visit denials, vaccine payer mismatches) and tailored appeals.
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Training and process updates to stop recurring pediatric denial patterns.
Accounts Receivable (A/R) & Patient Statements
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Age-friendly statements that explain vaccines, co-pays, and parent responsibility clearly.
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Payment plan setup for families, automated reminders, and secure online pay options.
Medicaid / CHIP Expertise & State-Specific Rules
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State-by-state Medicaid/CHIP knowledge and claim handling practices (essential because pediatric practices often have a large Medicaid mix).
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Eligibility workflows that check for Medicaid managed care carve-outs and state-specific vaccine rules.
Compliance & Audit Readiness
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Documentation audits, vaccination program compliance support, and HIPAA-secure workflows.
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CAQH / NPPES / provider enrollment maintenance to avoid payer rejections.
Reporting & Advisory
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Monthly KPIs: net collection rate, denial rate by reason (preventive, vaccine, eligibility), A/R days, payer mix.
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Actionable recommendations to improve front-desk scripts, documentation templates, and revenue capture.
Benefits of Choosing Sirius Solutions Global
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Specialized Pediatric Focus – Compared to those of other invoicing firms, we better grasp the complexity of pediatric care.
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Faster Payments – Our approach to prevent denials and clean claim submissions lowers payment delays.
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Revenue Growth – Within months of working with us, practices see up to a 30% revenue increase.
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Compliance Guaranteed – Always aligned with HIPAA and payer policies.
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Dedicated Account Managers – Humanized assistance designed to fit the needs of your practice, devoted account managers.
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Human Touch with Technology - expert billers combined with AI-driven claim sc
Why pediatric billing needs its own specialist
Pediatric billing isn’t “medical billing, but smaller.” It has its own rules, pain points, and revenue opportunities:
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High preventive visit volume. Well-child visits use specific CPTs (e.g., 99381–99397 series) and vaccine administration rules; documentation and coding need to match the preventive intent. Incorrect pairings lead to denials.
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Vaccine, vaccine administration & inventory billing. Vaccines, program funding (VFC), and private insurance billing must be carefully separated and documented to prevent billing errors and supply losses.
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Frequent payer switches. Families change plans, move between commercial insurance and Medicaid/CHIP eligibility checks at each visit are essential.
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Age-specific ICD-10 codes and congenital conditions. Pediatric coding uses age-specific codes that must support billed services.
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High patient volume & multi-family management. Sibling visits, school forms, and high throughput require efficient front desk and billing coordination.
Because of these differences, pediatric practices that use a generalist biller often experience avoidable denials, missed vaccine billing revenue, and strained patient relationships. A pediatric-specialized RCM partner closes those gaps.
Common pediatric billing challenges & how we solve them
Below are frequent real-world problems we see (and fix) for pediatric clients.
Challenge: Preventive vs Problem Visit Denials
Why it happens: A child comes for a well visit and also is treated for an acute issue the same day. If documentation or code pairing isn’t clear, payers may deny one service.
How we fix it: We use smart claim scrub rules, documentation templates, and staff scripts so both services (if medically necessary) can be supported and billed appropriately.
Challenge: Vaccine & VFC Billing Complexity
Why it happens: Vaccines may be supplied under state programs (VFC) or billed to commercial payers; misclassification leads to lost revenue or audit exposure.
How we fix it: We reconcile NDCs to claims, separate program-supplied vaccines from billable ones, and maintain audit trails for VFC inventories.
Challenge: Frequent Insurance Changes (Eligibility Issues)
Why it happens: Families change plans, move states, or have CHIP/Medicaid transitions claims submitted with incorrect payer details get denied.
How we fix it: Eligibility checks at scheduling and check-in, automated insurance verification reminders, and fast re-billing if coverage changes.
Challenge: Age-specific ICD-10 Coding Errors
Why it happens: Pediatric codes include congenital and developmental conditions that are age-dependent; miscoding triggers denials.
How we fix it: Pediatric-trained coders use age validation rules and EHR templates that suggest correct ICD-10 codes based on entered diagnoses and patient age.
Challenge: High Volume, Low Margin Throughput
Why it happens: Pediatric practices see many short visits; any delay in claim submission or follow-up compounds revenue loss.
How we fix it: Automated scrubbing, prioritized A/R queues, and efficient batch submission processes to keep cash flow steady.
Typical outcomes our pediatric clients see
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Reduced denials by targeting the 3–5 most frequent pediatric denial reasons (modifier errors, vaccine mismatches, Medicaid eligibility).
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Faster days-to-pay due to improved first-pass acceptance from payer-specific scrubbing.
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Improved HEDIS/EPSDT compliance through embedded quality-check templates and registry reconciliation.
How AI Transforms Pediatric Billing
Designed to simplify the billing procedure and minimize errors costing clinics thousands of dollars, our AI-powered tools are not only for task automatization. For your personnel, our artificial intelligence acts as a decision-support companion:
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Precise Coding Recommendations: development assessments and chronic condition management.
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Denial Prediction and Prevention: Artificial intelligence flags concerns proactively and forecasts possible rejections before a claim is filed by comparing it against payer-specific guidelines.
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Real-Time Eligibility Checks: Immediate verification of insurance coverage helps your front office avoid shocks for families while guaranteeing your practice gets paid more quickly via real-time eligibility checks.
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Intelligent Claim Tracking: AI continuously scans submitted claims and notifies your team of any rejections, underpayments, or delays so no income is lost behind.
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Data-Driven Insights: Artificial intelligence finds hidden revenue opportunities by means of patterns in your billing history, therefore helping your company make more economically sound judgments.
Why Pediatricians Trust Sirius Solutions Global
Pediatricians rely on us because we are long-term growth partners who help them to maximize their practice revenue, not just bill. You may devote all of your attention to patient care instead of hunting for payments or handling rejected claims. Your practice will be guaranteed honesty, accuracy, and continued support thanks to our humanized billing method.
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