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.
Pediatric Billing Specialists · AAPC/AHIMA Certified Coders
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.
What We Commit To IN WRITING
14 days, AR Review Cycle, aged claims worked on schedule
Claims scrubbed before submission Every claim
Coders holding AAPC/AHIMA credentials Every coder
BAA signed before any PHI moves Every client
Pricing from 2.29% of collections No setup fee · No lock-in
Why ClainetRCM
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.
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
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
Common Pain Points
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.
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.
Our Services
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.
Coding Expertise
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
How It Works
Our Simple Onboarding Process
- 1
Free Practice Audit
We review your billing performance and identify revenue leaks at zero cost.
- 2
Custom Strategy
A tailored RCM plan for your payer mix, practice size, and EHR system.
- 3
Seamless Transition
Full onboarding with zero disruption to daily workflow or patient care.
- 4
Optimize & Grow
Ongoing reporting and improvements to keep revenue trending upward.
Why Us
Why Pediatricians and Pediatric Practices Choose ClainetRCM
- 1
Pediatric-Exclusive Billing Expertise
Specialty-specific pediatric billing precision that general RCM companies simply cannot match.
- 2
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.
- 3
Dedicated Pediatric Billing Team
A named account manager and billing team who know your practice, payers, and patient population inside out.
- 4
Technology Plus Human Intelligence
Advanced RCM software backed by certified human pediatric coders and billers. No unreliable AI-only black boxes.
- 5
What Your Practice Gets, In Writing
Claim submission 24-48 hrs
Onboarding to first live claim 7-14 days
Aged AR reviewed Every 14 days
Coding by AAPC/AHIMA coders Every claim
Signed BAA before PHI access Every client
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.
FAQ
Frequently Asked Questions About Pediatric Medical Billing
ClainetRCM provides medical billing services to all healthcare providers, but we maintain a dedicated pediatric billing team with deep expertise in immunization billing, EPSDT screening claims, well-child visit coding, and age-specific E/M documentation required by US payers.
We integrate with all major EHR and practice management systems used by US pediatric practices including eClinicalWorks, Athenahealth, DrChrono, Kareo, Practice Fusion, Epic, NextGen, and many more. No software changes are required on your end.
Our pediatric billing specialists track each state's Medicaid and CHIP requirements in real time. We handle all EPSDT claims, fee schedule updates, prior authorization requirements, and state-specific billing rules to maximize your government payer reimbursements.
Onboarding takes 7 to 14 business days, after which we file your claims within 24 to 48 hours of receiving charges and review aged AR every 14 days. We will not promise you a revenue percentage we have not measured on your own data. What we will do is baseline your current denial rate and AR days at the start of the engagement and report against that baseline every month, so you can see exactly what changed.
No. ClainetRCM offers flexible month-to-month service arrangements. We believe our pediatric billing results speak for themselves, and we earn your continued business through performance, not contractual lock-in agreements.
Yes. ClainetRCM is fully HIPAA compliant. We sign Business Associate Agreements with all clients, enforce strict data security protocols, and conduct regular security audits to ensure your pediatric patient data is protected to the highest US healthcare standards at all times.
Free Consultation
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 Audit We identify lost revenue and billing gaps in your current setup
- Response Within 1 Business Day A dedicated pediatric billing specialist will reach out quickly
- 100% Confidential Process All practice information is protected under a strict NDA
- Zero Obligation The audit is completely free with no commitment required
Request Your Free Consultation
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.