Pediatrics Billing Services for Practices That Care for Every Child, Every Stage
Pediatric practices juggle age-based coding bands, immunization reporting, developmental screening, newborn care, and a heavy Medicaid and CHIP payer mix. ProvidaRCM manages the full revenue cycle for pediatric and family medicine practices, from eligibility and EPSDT verification through vaccine coding, claim submission, denial management, and A/R follow-up.
Recommended well-child visits by age
Well-child visit cadence follows the Bright Futures/AAP Periodicity Schedule. Codes shown are general reference, verify the correct age band and current description before billing.
Why Pediatrics Billing Demands Specialized Revenue Cycle Knowledge
Pediatric billing is shaped by age-banded coding, vaccine product and administration pairing, developmental screening, and a Medicaid and CHIP payer mix that varies by state and plan.
Pediatric practices bill across narrow age bands that change the correct code. A preventive visit for an infant, a toddler, a school-age child, and an adolescent each uses a different preventive medicine code, and the age band must match the patient's age on the date of service. Selecting the wrong band is a common, avoidable denial.
Immunizations add another layer. Every visit may bundle a vaccine product code, an administration code, and a counseling component, and the correct administration code depends on the patient's age and whether counseling was provided. Modifier 25 is frequently needed when a well-child visit and a sick visit occur on the same day.
Because a large share of pediatric patients are covered by Medicaid and CHIP, pediatric billing lives and dies by state and managed care plan rules, EPSDT periodicity, and prior authorization. Each program applies its own timely filing windows, authorization requirements, and claim formats. Our medical billing services and medical coding services are built around these pediatric realities.
ProvidaRCM brings coders trained on pediatric workflows, the CPT, HCPCS, ICD-10, and modifier combinations pediatricians actually use, and the payer policies that shape reimbursement. We catch errors before claims are submitted, not after they are denied.
What makes pediatrics billing complex
- Age-banded preventive and E/M codes
- Vaccine product plus administration pairing
- Developmental and behavioral screening
- Newborn and nursery care coding
- Same-day well and sick visits, modifier 25
- Heavy Medicaid and CHIP payer mix
- EPSDT periodicity and screening codes
- State-specific plan rules and formats
- Adolescent confidentiality considerations
Pediatrics Services We Bill
From newborn nursery care to adolescent well visits, ProvidaRCM supports the full range of services pediatricians deliver. Each category carries distinct coding and documentation requirements.
Well-Child & Preventive Visits
Preventive medicine codes are age-banded and follow the Bright Futures periodicity schedule. We match the code to the patient's age and verify preventive benefits.
- New patient preventive (99381-99387)
- Established preventive (99391-99397)
- Bright Futures screening and anticipatory guidance
- Developmental and behavioral screening
- Vision and hearing screening
- Anemia and lead screening where indicated
Immunizations & Vaccines
Every immunization combines a vaccine product code with an administration code. The correct administration code depends on age and whether counseling was provided.
- Vaccine product codes (CPT 906xx, 907xx)
- Administration with counseling (90460-90461)
- Administration without counseling (90471-90474)
- Same-day multiple vaccine reporting
- State vaccine registry and VFC coordination
- Counseling documentation support
Newborn & Nursery Care
Newborn care uses dedicated E/M codes and depends on whether the infant is normal, at risk, or premature. We select the correct code based on documentation and weight where applicable.
- Initial and subsequent newborn care (99460-99463)
- Nursery and high-risk newborn (99477)
- Neonatal critical care (99291-99295)
- Circumcision when documented (54150-54160)
- Newborn screening test reporting
- Transitional care after discharge
Sick Visits & Acute Care
Acute visits for common pediatric conditions use standard E/M codes. When a sick visit occurs on the same day as a well visit, modifier 25 and correct code pairing are essential.
- Office E/M new and established (99202-99215)
- Otitis media, upper respiratory, and asthma
- Same-day well and sick visit with modifier 25
- Minor in-office procedures
- Point-of-care and laboratory testing
- After-hours and urgent visit reporting
Chronic & Behavioral Conditions
Pediatric chronic conditions such as asthma and ADHD require accurate diagnosis specificity and ongoing management coding, including behavioral and developmental screening.
- Asthma and chronic respiratory conditions
- ADHD evaluation and management
- Developmental screening (96110, 96127)
- Behavioral and emotional assessment
- Chronic care management where applicable
- Coordination with specialists and referrals
Telehealth & Adolescent Care
Telehealth and adolescent visits carry payer-specific coverage rules and confidentiality considerations. We verify the modality, place of service, and consent requirements.
- Telehealth E/M with correct place of service
- Audio-video (95) and audio-only (93) modifiers
- Adolescent confidential services where applicable
- Sports and school physical documentation
- Reproductive and behavioral health visits
- Payer telehealth coverage verification
The Pediatric Immunization Schedule
The CDC-recommended childhood immunization schedule drives much of pediatric claim volume. This reference shows the typical ages and vaccine groupings. Always confirm the current schedule and payer-specific vaccine coverage before billing.
| Vaccine Group | Birth | 2 mo | 4 mo | 6 mo | 12-15 mo | 15-18 mo | 4-6 yr | 11-12 yr |
|---|---|---|---|---|---|---|---|---|
| Hepatitis B | ||||||||
| Rotavirus | ||||||||
| DTaP | ||||||||
| Hib | ||||||||
| Pneumococcal (PCV) | ||||||||
| IPV (Polio) | ||||||||
| Influenza | ||||||||
| MMR | ||||||||
| Varicella | ||||||||
| Hepatitis A | ||||||||
| HPV | ||||||||
| Tdap / Meningococcal |
Schedule reflects the general CDC-recommended childhood immunization pattern. Coverage, product availability, and ages vary by payer, state, and current guidance. Verify against the current schedule and payer policy before billing, and report only vaccines actually administered and documented.
Recommended dose Annual / seasonPediatrics Code Reference
Browse the CPT, HCPCS, ICD-10, and modifier codes pediatric practices use most. Code descriptions are general reference. Always confirm current descriptions and payer-specific guidelines before billing.
CPT / HCPCSOffice, preventive, vaccine & newborn
+Commonly used pediatric CPT and HCPCS codes. Not every code applies to every practice. Codes must be supported by provider documentation.
| Code | Service | Common Billing Consideration |
|---|---|---|
| 99460 | Initial hospital care, normal newborn | Used for the first E/M of a healthy newborn in the hospital. Confirm normal newborn status versus at-risk. |
| 99461 | Subsequent hospital care, normal newborn | Used for additional days of normal newborn hospital care beyond the initial day. |
| 99462 | Care of multiple normal newborns in hospital | Applies when more than one normal newborn is cared for in the hospital setting. |
| 99463 | Newborn admission under 8 days, normal newborn | Reports full newborn hospital stay under 8 days. Verify payer acceptance of bundled code. |
| 99477 | Initial hospital care for high-risk newborn | For initial evaluation of a high-risk newborn, time-based. Distinguish from normal newborn codes. |
| 99291 | Initial neonatal or pediatric critical care | For critically ill neonate or child, time-based. Requires detailed documentation of critical illness. |
| 99292 | Additional 30 minutes of neonatal critical care | Add-on to 99291 for each additional 30 minutes. Document total critical care time. |
| 99381 | Preventive visit, new patient, infant | Age band infant, new patient. Confirm new patient 3-year rule and age on date of service. |
| 99382 | Preventive visit, new patient, ages 1-4 | Match to the patient's exact age band. Wrong age band is a common denial cause. |
| 99383 | Preventive visit, new patient, ages 5-11 | School-age preventive; include required screenings for the age group. |
| 99384 | Preventive visit, new patient, ages 12-17 | Adolescent preventive; include behavioral and developmental screening. |
| 99391 | Preventive visit, established patient, infant | Established infant preventive. Verify prior preventive history. |
| 99392 | Preventive visit, established patient, ages 1-4 | Toddler and preschool established preventive. |
| 99393 | Preventive visit, established patient, ages 5-11 | School-age established preventive. |
| 99394 | Preventive visit, established patient, ages 12-17 | Adolescent established preventive; document screening and counseling. |
| 90460 | Immunization admin through 18 yrs, with counseling, first component | Requires face-to-face counseling. Use for patients within the age limit and when counseling is documented. |
| 90461 | Immunization admin, each additional vaccine component, with counseling | Add-on to 90460. Report one per additional vaccine component administered with counseling. |
| 90471 | Immunization admin, one vaccine, any route | Used when counseling is not the basis for reporting. One per encounter for the first vaccine. |
| 90472 | Immunization admin, each additional vaccine | Add-on to 90471 for each additional vaccine given by injection the same day. |
| 90473 | Immunization admin, one oral vaccine | For the first oral vaccine, such as rotavirus, when counseling is not the basis. |
| 90474 | Immunization admin, each additional oral vaccine | Add-on to 90473 for each additional oral vaccine the same day. |
| 90670 | Pneumococcal conjugate vaccine (PCV) | Report the product code plus the correct administration code. Confirm current product availability. |
| 90647 | Hib vaccine, PRP-T conjugate | Product code paired with an administration code. Verify VFC versus private stock. |
| 90700 | DTaP vaccine | Pediatric combination. Pair with administration code and report per schedule. |
| 90698 | DTaP-IPV/Hib combination vaccine | Combination product. Report component administration per payer rules and product documentation. |
| 90707 | MMR vaccine | Report with administration code. Confirm the documented route and age indication. |
| 90710 | MMRV vaccine | Combination MMR and varicella. Payer preference between MMRV and separate dosing may vary. |
| 90716 | Varicella vaccine | Report with administration code per schedule. |
| 90744 | Hepatitis B vaccine, preservative-free | Confirm the product and dose schedule on the date of service. |
| 90651 | HPV vaccine, 9-valent | Adolescent series. Verify age, schedule, and payer coverage. |
| 90686 | Influenza vaccine, quadrivalent, injectable | Seasonal product. Pair with administration code and confirm current season's product. |
| 96110 | Developmental screening, standardized instrument | Report when a standardized developmental screening tool is administered and scored. |
| 96127 | Brief emotional or behavioral assessment | For standardized screening such as depression or behavioral risk. Verify payer coverage and limits. |
| 54150 | Circumcision, using clamp or similar device | Confirm medical necessity, documentation, and payer coverage. Varies by payer and circumstance. |
| 54160 | Circumcision, dorsal slit or other technique | Report per documentation. Confirm payer-specific coverage before billing. |
CPT and HCPCS codes and descriptions are provided for general reference only and may change annually. Always verify against the current AMA CPT code set, CDC schedule, and payer guidelines.
ICD-10Common pediatric diagnoses
+Common pediatric diagnoses. Diagnosis coding must reflect the provider's documentation and the reason for the encounter. Code to the highest specificity supported.
| Code | Description | Common Use |
|---|---|---|
| Z00.110 | Health examination for newborn under 8 days old | Newborn well exam in hospital. Distinguish from routine child exam codes. |
| Z00.111 | Health examination for newborn 8 to 28 days old | Newborn well exam after discharge within the first month. |
| Z00.121 | Routine child health examination, 8 to 28 days old | Routine well-child visit in the late newborn period. |
| Z00.129 | Routine child health examination, 29 days to 17 yrs | Most routine well-child visits beyond the newborn period. |
| Z23 | Encounter for immunization | Report with every vaccine administration to indicate the reason for the encounter. |
| Z76.1 | Encounter for health supervision, foundling or newborn | Used in specific newborn supervision contexts; verify correct code versus Z00.xx. |
| Z13.6 | Encounter for screening for cardiovascular disorders | Screening such as lipid or cardiovascular risk in children when indicated. |
| Z13.220 | Encounter for screening for developmental delays | Developmental screening encounter; pair with screening code 96110 when performed. |
| Z13.4 | Encounter for screening for developmental and behavioral issues | Behavioral and developmental screening context. |
| J06.9 | Acute upper respiratory infection, unspecified | Common acute pediatric visit diagnosis. Document signs and symptoms. |
| J20.5 | Acute bronchitis due to respiratory syncytial virus | Specify organism when documented rather than using unspecified bronchitis. |
| J45.901 | Unspecified asthma with (acute) exacerbation | Acute asthma flare. Specify type and severity when documentation supports it. |
| H66.90 | Otitis media, unspecified, unspecified ear | Common pediatric ear infection. Specify laterality and type when documented. |
| R50.9 | Fever, unspecified | Symptom code for fever when no definitive diagnosis is documented. |
| R05.9 | Cough, unspecified | Symptom code used pending a definitive respiratory diagnosis. |
| R63.3 | Feeding difficulties | Used when feeding issues are documented without a more specific diagnosis. |
| R62.50 | Lack of expected physiological development, unspecified | Developmental concern; specify the domain when documentation supports it. |
| F90.9 | Attention-deficit hyperactivity disorder, unspecified type | Specify type when documented. Support with screening and evaluation notes. |
| E55.9 | Vitamin D deficiency, unspecified | Often identified at newborn or infant screening. Confirm with documentation. |
| E03.9 | Hypothyroidism, unspecified | May follow newborn screening. Specify type when documented. |
| P07.0 | Extreme immaturity of newborn | Used for extremely low gestational age newborns. Verify gestational age documentation. |
| E66.9 | Obesity, unspecified | Use BMI codes with obesity; document class when available. Common in adolescent care. |
ICD-10-CM codes are provided as a general reference. Do not report a diagnosis that is not supported by the provider's documentation. Upcoding or unsupported diagnosis reporting is not appropriate.
ModifiersPediatric scenarios
+Modifiers frequently used in pediatrics. Report modifiers only when supported by documentation and payer requirements. A modifier does not automatically guarantee separate reimbursement.
| Modifier | General Purpose | Common Pediatric Scenario | Important Consideration |
|---|---|---|---|
| 25 | Significant, separately identifiable E/M same day as a procedure or vaccine | Well-child visit plus a sick visit, or E/M with a separately identifiable service the same day. | Documentation must show the E/M was beyond the usual work of the preventive visit or procedure. |
| 33 | Preventive service | Preventive and screening services that should be covered without cost sharing under applicable law. | Used to signal a preventive service. Coverage rules depend on payer, plan, and applicable regulations. |
| 59 | Distinct procedural service | Two services not normally reported together that were performed distinctly. | Use only when no other modifier describes the situation. Documentation must support distinctness. |
| 24 | Unrelated E/M during a postoperative period | Unrelated visit during a procedure's global period, such as an unrelated sick visit. | Document that the visit is unrelated to the original procedure. |
| 52 | Reduced services | Partial administration of a service when the full service was not completed. | Use when a planned service is reduced; document the reason. |
| 95 | Synchronous telemedicine via interactive audio and video | Telehealth pediatric visit using a qualifying audio-visual platform. | Payer and plan telehealth rules vary; verify coverage and originating site rules. |
| 93 | Synchronous telemedicine via audio only | Audio-only telehealth visit when video is unavailable or clinically not required. | Acceptability depends on payer, plan, service, and applicable regulations. |
| XE | Separate encounter | Separate service on the same day that is distinct by encounter. | Part of the X{EPSU} modifier family; use when applicable and supported. |
| 76 | Repeat procedure by the same physician | Same service repeated the same day by the same provider. | Document the medical necessity for the repeat. |
Modifier use must be supported by documentation and payer policy. Improper modifier use, especially on same-day well and sick visits and vaccines, is a leading cause of pediatric denials and audits.
Common Pediatrics Denials and How We Resolve Them
Pediatric denial patterns fall into recurring categories driven by age-banded coding, vaccine pairing, and Medicaid rules. Understanding each is the first step toward preventing it.
Vaccine & Administration Errors
- Wrong administration code for age or counseling
- Missing product code or mismatched product and administration
- VFC versus private stock reporting errors
Age-Band & Coding Errors
- Preventive code age band mismatch
- Invalid CPT and ICD-10 combinations
- Missing modifier 25 on same-day well and sick visits
Medicaid & Eligibility
- Inactive Medicaid or CHIP coverage at service
- Wrong managed care plan billed
- Missing EPSDT screening documentation
| Denial Type | Why It Happens | How ProvidaRCM Addresses It |
|---|---|---|
| Wrong Preventive Age Band | Preventive code selected does not match the patient's age on the date of service. | We verify the patient's age against the code's age band before submission and correct mismatches. |
| Vaccine Pairing Errors | Administration code does not match the vaccine product, age, or counseling status. | Coders confirm the product, administration code, and counseling documentation before billing each vaccine. |
| Missing Modifier 25 | Same-day well and sick visit, or E/M with a vaccine, billed without the modifier. | Our scrubber identifies same-day preventive and problem combinations and applies modifier 25 when supported. |
| Medicaid Eligibility | Inactive Medicaid or CHIP, or the wrong managed care plan billed. | Real-time eligibility verification before each encounter catches inactive plans and plan changes. |
| EPSDT Documentation | Screening elements not documented to meet program periodicity requirements. | We track EPSDT periodicity and flag missing screening components before claim creation. |
| Authorization Missing | A service required prior authorization that was not obtained. | Prior auth tracking and payer-specific requirement lists prevent unauthorized services from being billed. |
| Timely Filing | Claim submitted past the payer's filing deadline, which varies by Medicaid plan. | We track filing windows by payer and plan and prioritize aging claims approaching deadlines. |
| Duplicate Claims | Same service resubmitted or corrected claim mishandled. | Submission controls and corrected claim logic prevent duplicate and rejected resubmissions. |
| Diagnosis Specificity | Unspecified code used when a more specific diagnosis is documented. | We code to the highest specificity supported by documentation to avoid medical necessity denials. |
| Telehealth Denials | Wrong place of service, modifier, or unlisted telehealth benefit. | We confirm payer telehealth rules, place of service, and audio-video requirements per claim. |
Medicaid, CHIP, and EPSDT Pediatric Billing
A large share of pediatric patients are covered by Medicaid and CHIP. Each state and managed care plan applies its own rules, and EPSDT screening requirements add documentation complexity.
State & Managed Medicaid
Medicaid rules vary by state and managed care plan. We adapt to each program's requirements rather than applying universal assumptions.
- Eligibility and member verification per plan
- State-specific claim formats and portals
- Prior authorization where the plan requires it
- Timely filing windows that differ by plan
- Coordination of benefits with other coverage
CHIP Coverage
CHIP covers children above Medicaid income limits and has its own plan structures and rules that differ from Medicaid and commercial plans.
- CHIP eligibility and enrollment verification
- Separate versus Medicaid-expansion CHIP plans
- Premium and cost-sharing rules where applicable
- Preventive and immunization coverage verification
- Plan-specific claim submission requirements
EPSDT Screening
The Early and Periodic Screening, Diagnostic, and Treatment benefit requires periodic screening at set intervals. Documentation must support each screening component.
- Periodicity schedule tracking by age
- Screening component documentation
- Required vision, hearing, and dental screening
- Developmental and behavioral screening
- Referral and follow-up tracking
Medicaid, CHIP, and EPSDT requirements differ by state, plan, service, and applicable regulations, and they change frequently. We verify the specific rules for each claim and maintain payer-specific requirement lists so nothing is assumed.
Front-End Work That Prevents Most Denials
The majority of avoidable pediatric denials start at the front desk. Eligibility verification and prior authorization tracking remove the most common causes before a claim is ever created.
Eligibility & Benefits Verification
Before every encounter, ProvidaRCM verifies active coverage, member information, pediatric benefits, copays, deductibles, coinsurance, and out-of-pocket accumulators. We confirm preventive benefits, immunization coverage, EPSDT periodicity, referral requirements, authorization requirements, and network status, including the correct Medicaid or CHIP managed care plan.
Front-end eligibility verification reduces avoidable claim denials, including inactive Medicaid, wrong managed care plan, and coordination of benefits issues. When families understand their responsibility up front, downstream collection improves and billing disputes decline.
Prior Authorization for Pediatrics
Authorization requirements affect more pediatric services than many practices expect. Certain vaccines or combination products, imaging, specialist referrals, selected medications, therapies, durable medical equipment, and some procedures may require approval. Requirements vary by payer and plan, and they change frequently.
ProvidaRCM maintains payer-specific prior authorization requirement lists, submits complete requests with supporting clinical documentation, and follows up until authorization is confirmed. We track every authorization so providers can see status before the service is delivered.
What we verify
- Active coverage and member information
- Correct Medicaid or CHIP managed care plan
- Pediatric benefits and network status
- Copays, deductibles, and coinsurance
- Preventive and immunization benefits
- EPSDT periodicity and screening status
- Referral and authorization requirements
- Telehealth coverage and place of service
From Charge Capture to Payment, Managed End to End
Every pediatric claim moves through a disciplined workflow. Each stage has its own checks so problems are caught early rather than recovered late.
Charge Capture
Charges and vaccines are captured from the encounter and reconciled against the schedule.
Documentation Review
Notes reviewed for screening components, counseling, and procedures before coding.
Coding
Certified coders apply CPT, HCPCS, ICD-10, and modifiers based strictly on documentation.
Claim Scrubbing
Automated and manual scrubbers check edits, bundling, vaccine pairing, and payer rules.
Payer Validation
Claims validated against the specific payer, including the correct Medicaid plan.
Submission
Clean claims submitted electronically through the clearinghouse to the payer.
Denial Management
Denials categorized, corrected, and appealed within payer timelines.
A/R & Posting
A/R worked every cycle and payments posted with line-item accuracy.
A rejected claim never entered the payer's adjudication system because of a formatting or eligibility error and is fixed and resubmitted. A denied claim was adjudicated and refused for a substantive reason such as medical necessity or authorization, and requires correction, appeal, or additional documentation. Effective denial management focuses on both recovery and prevention.
A/R Management and Payment Posting
Consistent follow-up and accurate posting are what turn submitted claims into actual cash in the bank, especially across a mixed Medicaid, CHIP, and commercial payer mix.
Pediatrics A/R Management
Unpaid and underpaid claims are the quiet revenue leak in pediatric practices. ProvidaRCM works aging A/R systematically to recover stalled revenue across every plan.
- Aging A/R worked in priority buckets by payer and plan
- Insurance follow-up on unpaid and stalled claims
- Underpayment identification against contracted rates
- Appeals for denied and partially paid claims
- Patient balance management and statement support
- Root-cause analysis to stop recurring delays
Payment Posting & Reconciliation
Accurate posting is the foundation of reliable reporting. We post every remit line and reconcile against expected reimbursement across all payer types.
- ERA and EOB posting with line-item accuracy
- Insurance payments and patient responsibility separated
- Contractual adjustments and denials posted correctly
- Recoupments and secondary insurance coordination
- Reconciliation to identify missing or short payments
- Underpayment flags against contracted rates
Consistent follow-up protects cash flow. Claims that sit without attention are the most common reason healthy practices develop sudden cash shortfalls. Our team works A/R every cycle so nothing quietly ages past recovery.
In-House Billing vs ProvidaRCM
Running pediatric billing in-house is more expensive and less reliable than most practices assume, especially with a heavy Medicaid and vaccine reporting workload.
| Factor | In-House Billing | ProvidaRCM |
|---|---|---|
| Staffing | Hire, train, and retain billers and coders at your cost. | Built-in team, no hiring, turnover, or coverage gaps to manage. |
| Specialty Expertise | Generalist staff may lack pediatric coding depth. | Coders trained on pediatric and vaccine coding rules. |
| Vaccine Coding | Product and administration pairing errors common. | Vaccine product and administration coding verified before submission. |
| Medicaid & CHIP | State and plan rules hard to track in-house. | Payer-specific requirement lists maintained for each plan. |
| Denial Management | Handled as time permits, often inconsistently. | Structured denial recovery and recurrence prevention. |
| A/R Follow-Up | Competes with other front-office duties. | Dedicated follow-up on every cycle, no stalled claims. |
| Reporting | Manual and often delayed. | Regular dashboards on collections, denials, and A/R aging. |
| Scalability | Adding providers means adding staff and cost. | Scales with your volume without proportional overhead. |
| Administrative Burden | Falls on the practice and providers. | We take on the administrative side so providers focus on care. |
Why Pediatric Practices Choose ProvidaRCM
We work like an extension of your practice, focused on the pediatric revenue cycle from first eligibility check to final payment.
A billing partner that operates like an extension of your practice
Pediatric revenue depends on capturing the right code for every age band, pairing every vaccine correctly, following up on every claim, and appealing every legitimate denial. ProvidaRCM brings the people, processes, and reporting to do that consistently without adding to your staff's workload.
Pediatric Expertise
Teams trained on age-banded coding, vaccines, and EPSDT screening requirements.
Certified Coders
AAPC-certified coders who understand pediatric and newborn workflows.
Vaccine Coding
Product and administration pairing verified before every submission.
Medicaid & CHIP
State and plan-specific rules maintained for each program.
Eligibility Verification
Real-time verification before encounters prevents avoidable denials.
Prior Authorization
Authorization tracked and confirmed before services are delivered.
Denial Management
Every denial categorized, corrected, and appealed within payer timelines.
A/R Follow-Up
Aging balances and stalled claims worked consistently every cycle.
Transparent Reporting
Regular dashboards on collections, denials, and A/R aging by payer.
HIPAA-Compliant
Workflows aligned with HIPAA to protect patient information at every step.
Reduced Workload
We take on the administrative side so your team can focus on patient care.
Reliable Coverage
Operational coverage that does not depend on a single in-house biller.
See Exactly Where Your Practice Is Losing Revenue
A free pediatric billing audit shows where revenue is leaking and how to stop it. We review your billing with no obligation.
Avg. aged A/R recovered per engagement
Pediatrics Billing Questions, Answered
Practical answers to the questions pediatric practices ask before partnering with ProvidaRCM.
In addition to pediatrics, ProvidaRCM provides specialty billing for related practices, including family medicine billing, mental health billing, orthopedic billing, gastroenterology billing, and chiropractic billing. You can also browse our full specialties directory.
Recover Lost Revenue and Reduce Denials Across Your Pediatric Practice
Pediatrics rewards practices that code by age band, pair every vaccine correctly, follow up relentlessly, and appeal every legitimate dollar. ProvidaRCM handles the administrative side of revenue cycle management so your providers can focus on patient care. Schedule a consultation, request a free billing audit, or tell us about your revenue cycle challenges.
What You Get With ProvidaRCM
- Pediatric billing expertise
- AAPC-certified coders
- Vaccine coding verification
- Medicaid and CHIP support
- Custom reporting dashboards
- Month-to-month agreement