Pediatric Medical Billing and Revenue Cycle Management Services
ClainetRCM handles pediatric billing, coding, credentialing and virtual assistant services so you can focus on patients, not paperwork.
Pediatric billing requires a specialist, not a generalist.
- Vaccine administration billing (CPT 90460 to 90474)
- Well-child visit coding with age-specific requirements
- EPSDT screening for Medicaid and CHIP programs
- Developmental and behavioral health coding
- Complex multi-payer management across all 50 states
Specialized Pediatric Billing and RCM for Your Practice
Generic billing services leave pediatric revenue on the table. Our pediatric billing specialists understand immunization billing, EPSDT rules, and Medicaid/CHIP guidelines at a level that general RCM companies simply cannot match.
We serve solo pediatricians, group practices, FQHCs, and children's hospitals across every US state. Whether you are a solo provider or a 50-physician group, we scale with you.
- Deep expertise in pediatric CPT and ICD-10 codes
- Medicaid, CHIP and commercial insurance billing expertise
- Real-time pediatric claim denial management and appeals
- Works with eClinicalWorks, Athena, DrChrono and more
Why Pediatric Practices Lose Revenue and How We Fix It
These are the pediatric billing problems we are asked to fix most often. Here is exactly how ClainetRCM works each one.
Vaccine Billing Complexity
Immunization billing errors are a top cause of pediatric claim denials in the USA. We handle VFC program billing and all CPT administration codes flawlessly.
Medicaid and CHIP Claim Denials
We track every state Medicaid and CHIP policy change and update your billing protocols proactively to prevent revenue loss from government payer denials.
Well-Visit Undercoding
We capture every billable service including developmental screenings, preventive care add-ons, and age-specific codes your current billing process is missing.
Slow Insurance Reimbursements
We file pediatric claims within 24 to 48 hours of receiving charges and review aged accounts receivable every 14 days, so nothing sits and ages quietly.
Provider Credentialing Gaps
Unenrolled providers lose revenue from day one. We deliver full payer credentialing management including enrollment, renewals, and CAQH profile updates.
No Revenue Reporting Visibility
ClainetRCM provides real-time dashboards with pediatric-specific KPIs so you always have full visibility into your revenue cycle performance and collections.
Pediatric Medical Billing and RCM Services We Provide
Complete pediatric revenue cycle management solutions for solo providers, group practices, clinics, and children's hospitals across the United States.
Pediatric Medical Billing Services
End-to-end pediatric claim submission, accounts receivable follow-up, payment posting, and denial management. Our pediatric billing specialists maximize your collections from day one.
Pediatric Medical Coding Services
AAPC-certified pediatric coders specializing in vaccine billing, EPSDT, well-child visits, and behavioral health codes to reduce audit risk and capture every reimbursable service.
Pediatric Provider Credentialing
Get your pediatric providers enrolled with Medicaid, CHIP, TRICARE, and all commercial payers fast. We manage renewals, re-attestations, and CAQH profile maintenance.
Medical Virtual Assistant Services
Dedicated remote medical virtual assistants handling prior authorizations, appointment scheduling, insurance verification, and patient communications for your pediatric practice.
Full Revenue Cycle Management
One trusted partner for your entire pediatric revenue cycle. From patient eligibility verification through claim submission, payment posting, reporting, and practice analytics.
Healthcare Compliance and Audit Support
HIPAA compliance reviews, documentation improvement programs, and pediatric coding compliance assessments aligned with OIG guidelines to protect your practice from risk.
Pediatric CPT and ICD-10 Billing Codes We Master
Our AAPC-certified pediatric medical coders are trained on every pediatric-specific CPT, ICD-10, and HCPCS code used by US practices and hospitals.
Preventive Medicine Visits
Well-child exams from newborn through adolescence billed accurately
Immunization Administration
Vaccine administration billing with and without counseling
Developmental Screenings
ASQ, M-CHAT, CRAFFT and all developmental screening tools
Office and Outpatient E/M
Accurate E/M level selection with proper MDM documentation
Routine Child Health Exams
Age-appropriate pediatric encounter and diagnosis coding
Medicaid Early and Periodic Screening
EPSDT comprehensive services billed under state Medicaid plans
Our Simple Onboarding Process
Free Practice Audit
We review your billing performance and identify revenue leaks at zero cost.
Custom Strategy
A tailored RCM plan for your payer mix, practice size, and EHR system.
Seamless Transition
Full onboarding with zero disruption to daily workflow or patient care.
Optimize & Grow
Ongoing reporting and improvements to keep revenue trending upward.
Why Pediatricians and Pediatric Practices Choose ClainetRCM
- 01
Pediatric-Exclusive Billing Expertise
Specialty-specific pediatric billing precision that general RCM companies simply cannot match.
- 02
Performance-Based Pricing Model
Our fee is tied directly to your collections. We earn more only when you earn more, with no hidden charges ever.
- 03
Dedicated Pediatric Billing Team
A named account manager and billing team who know your practice, payers, and patient population inside out.
- 04
Technology Plus Human Intelligence
Advanced RCM software backed by certified human pediatric coders and billers. No unreliable AI-only black boxes.
What Your Practice Gets, In Writing
Ready to Maximize Your Pediatric Practice Revenue?
Get your free, no-obligation pediatric billing audit and discover exactly how much revenue your practice is leaving on the table each month.
Claim Your Free Pediatric Billing AuditFrequently Asked Questions About Pediatric Medical Billing
Request a Free Pediatric Billing Audit for Your Practice
Schedule a complimentary pediatric revenue cycle audit with a ClainetRCM specialist. We will identify exactly where your practice is losing revenue and how to recover it fast.
- Free Pediatric Revenue AuditWe identify lost revenue and billing gaps in your current setup
- Response Within 1 Business DayA dedicated pediatric billing specialist will reach out quickly
- 100% Confidential ProcessAll practice information is protected under a strict NDA
- Zero ObligationThe audit is completely free with no commitment required