Preventive Care Billing Services
Preventive care keeps patients healthy and reduces long-term costs, but getting paid for prevention is its own challenge. Well visits, immunizations, screenings, counseling, and care-gap outreach all have different billing rules, documentation needs, and payer quirks. At Sirius Solutions Global we translate prevention into predictable revenue so your clinicians can do what they do best: keep patients well.
What we do end-to-end preventive care billing
We treat preventive care billing like a specialty, because it is. Our services are designed to capture every legitimate source of revenue tied to prevention:
Intake & verification
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Real-time eligibility and benefits checks that flag preventive coverage, frequency rules, and vaccine benefits before the patient arrives.
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Pre-visit verification for screenings and bundled services to avoid surprise denials.
Documentation optimization
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Practical templates for well visits, counseling, and screening justification that make charting faster and richer, so payers accept the claim the first time.
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Time-capture workflows for counseling and behavior change visits so time-based codes are supported.
Accurate coding & claim submission
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Specialty-trained coders familiar with payer-specific edits, vaccine delivery policies, and preventive versus problem visit subtleties.
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To maximize first-pass acceptability, payer-specific claim scrubbing (NCCI, LCD/LCD rules, frequency edits).
Immunization & vaccine billing
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Correct capture of vaccine product codes, administration codes, and supply fees.
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Management of multi-dose series, age-based rules, and payer-specific reimbursement tables.
Screening & diagnostic follow-up
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Proper sequencing of screening tests and diagnostic follow-up (so you bill the right service at the right time).
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Handling of reflex testing and add-on codes for lab or imaging that follow screening positives.
Telehealth & virtual wellness visits
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Telemedicine billing rules for preventive care and hybrid visit models, we make sure tele-visits are billed accurately and defended in audits.
Care-gap closure & value-based support
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Outreach workflows tied to claims and quality metrics (HEDIS, pay-for-performance), increasing incentive payments through higher compliance rates.
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Reporting for population health teams to show ROI from outreach and preventive programs.
Denial management & appeals
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Fast root-cause analysis of preventive denials and immediate resubmission with supporting documentation.
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Appeals and payer negotiations for systemic issues that affect prevention revenue.
How our approach protects revenue and improves care
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Higher first-pass acceptance — fewer denials, less rework.
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Better quality scores — more completed preventive services and stronger performance on value-based metrics.
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Fewer delayed treatments — prior auths and eligibility checks handled upfront.
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Improved patient experience — transparent billing and clear statements for preventive services.
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Actionable analytics — dashboards that show care gaps, immunization rates, denials by payer, and net collections.
Why preventive care billing deserves a specialist
Preventive services are deceptively complicated. A single “well visit” can include multiple billable elements: vaccine administration, screening tests, counseling time, risk assessments, and referrals. Payers treat preventive services differently - Medicare, Medicaid, commercial plans and value-based contracts each have their own rules. Common pitfalls we see:
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Mixing up preventive vs problem-focused visit documentation (leads to downcoding).
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Missing vaccine administration modifiers or units for multi-dose vaccines.
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Poor capture of time-based counseling (e.g., tobacco cessation, obesity counseling).
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Care-gap and quality reporting misses (HEDIS, payer quality metrics) that reduce incentive payments.
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Telehealth preventive visits billed inconsistently after policy changes.
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Underutilized codes for chronic care prevention and transitional care.
When these things go wrong you don’t just lose one claim — you miss long-term incentive payments, value-based bonuses, and opportunities to improve patient outcomes.
Common preventive services we optimize billing for
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Yearly wellness appointments and well-child or well-adult evaluations
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Vaccinations and vaccine delivery: multidose series, flu, COVID-19, HPV, shingles, pediatric series
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Mammography, colon cancer screening processes, accurate sequencing, and follow-up coding are all examples of cancer screenings.
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Behavioral counseling (tobacco cessation, nutrition, and weight loss counseling) with time recording
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Workflow of reflex testing and screening labs
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Programs for preventing chronic diseases (diabetes prevention initiatives; prediabetes counseling)
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Preventive follow-ups after hospitalizations and transitional care
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Remote monitoring claim capture and telehealth preventative appointments
What working with us looks like simple, measurable, human
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Discovery & baseline audit — we identify missed services, coding gaps, and high-value opportunities.
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Workflow redesign — practical templates and small process changes that reduce denials without adding clinician burden.
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Technical integration — connect with your EHR/PM and care-gap systems; set up automated eligibility and pre-auth workflows.
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Go-live & parallel checks — we run side-by-side until you’re confident.
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Monthly reviews — clear KPIs: first-pass acceptance, prevention completion rate, days in A/R, and incentive payments recovered.
You’ll have a real account manager and a dedicated team — not a ticket system and a bot.
Technology & AI practical tools that reduce friction
We use modern tools to augment human expertise, not replace it. AI helps us catch the little things that cause big losses:
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Pre-submission AI scrubbing flags missing modifiers, mismatched age/gender rules for vaccines, or time-based documentation gaps.
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Denial prediction surfaces at-risk preventive claims so coders can correct them before submission.
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Population health connectors link billing data to care-gap management systems so outreach is focused and measurable.
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Smart reconciliation starts recovery procedures by identifying underpayments connected with preventive codes.
The outcome is better use of your staff's time, fewer refusals, and more accurate claims.
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