Pediatrics Billing Services Built for Pediatrics
Specialty billing for pediatric practices: well-child preventive visits, vaccine admin (VFC and private), same-day sick + well with modifier -25, and the Medicaid MCO mix that pediatrics actually deals with.
Why pediatrics is its own billing problem
Pediatrics looks simple until you bill it. Same-day sick + well requires modifier -25, and half the time it's denied anyway. Vaccine billing splits between VFC (state-supplied) and privately purchased, with different admin code logic. And the payer mix skews heavily Medicaid, with MCO-specific eligibility rules that change quarterly. Generic billers miss most of this.
- •Modifier -25 denied on combined sick + well visits, and never appealed
- •Vaccine admin underbilled because 90460/90461 components aren't captured per antigen
- •VFC vaccines billed as private (or vice versa), triggering audits
- •Medicaid MCO eligibility not verified same-day, causing avoidable denials
- •Developmental screening (96110) and behavioral screening (96127) not separately captured
What our medical billing service includes
A full revenue cycle, owned end-to-end by a Carevonix billing team trained on your specialty, your EHR, and your payer mix.
Clean claim submission
We code, scrub, and submit claims to commercial and government payers within 24 hours of the encounter. Average clean-claim rate: 94%.
Daily denial management
Every denial is worked within 48 hours, corrected, appealed, or written off with documentation. No more stale AR over 90 days.
Insurance eligibility verification
We verify benefits, copays, deductibles, and prior-auth requirements before the patient walks in, so claims aren't denied on day one.
Patient billing and statements
We send patient statements, handle balance questions, and offer payment plans, keeping collection rates high without straining the front desk.
Payer underpayment audits
We compare every EOB against your contracted rates and appeal underpayments. Most practices recover 3-7% they didn't know they were losing.
Monthly reporting that means something
Clean claim rate, days in AR, net collections rate, denial rate by payer, delivered monthly with a real human to walk you through what's working.
What practices see after switching
Average results across Carevonix billing clients within the first 90 days.
94%
Clean claim rate
67%
Reduction in AR over 90 days
12 days
Average days in AR
3-7%
Revenue recovered from underpayments
Why practices choose Carevonix for medical billing
There are plenty of medical billing companies. Most of them treat your practice like a row in a spreadsheet. We don't.
- Dedicated US-based billing team with the same people every month, not a rotating call center
- We work in your EHR and PM system. No data migrations, no parallel logins.
- Transparent monthly reporting with a named account lead, not a ticket queue
- HIPAA-aware workflows and a signed BAA before any PHI changes hands
- Flat monthly pricing with no per-claim percentages that punish growth
Built for Pediatrics practices
Pediatrics billing rewards Medicaid expertise and modifier discipline. Our team bills pediatric practices every day across well-child, sick + well, vaccine admin, and developmental screening, and we fight -25 denials instead of writing them off.
Pediatrics codes we work daily
99381-99395
Preventive E/M new and established (well-child)
99212-99215
Sick visit E/M
90460 / 90461
Vaccine admin with counseling (first / each additional)
96110 / 96127
Developmental and behavioral screening
90471 / 90472
Vaccine admin without counseling
Modifier -25
Significant separately identifiable E/M on same day
Where pediatrics revenue leaks
- •Same-day sick + well denied because modifier -25 wasn't appended (or appeal abandoned)
- •Vaccine admin counted as one code instead of per-antigen with 90461 add-ons
- •VFC vs private vaccine billing mistakes triggering payer audits
- •Screening codes (96110, 96127) not billed separately from well-child E/M
- •Medicaid MCO month-to-month plan switching breaking eligibility
Pediatrics payers we handle
- Medicaid MCOs (state-specific: CareSource, Anthem, Molina, Centene, etc.)
- BlueCross BlueShield commercial and Medicaid
- UnitedHealthcare Community Plan
- Tricare for military families
- Aetna and Cigna commercial
Frequently asked questions
Real questions practice owners ask before they switch.
Ready to see what Carevonix can do for your practice?
Book a 20-minute demo. We'll walk through your current workflows, your numbers, and exactly what would change.