MedCare MSO’s pediatric billing software handles all pediatric workflows, including age-specific coding, Medicaid-CHIP payer requirements, and vaccine administration rules through AI validation to process clean claims.
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Most pediatric billing software uses generic billing workflows and rules that aren’t compatible with specific requirements like age-specific billing. This is because pediatric billing includes more variables than most outpatient specialties. Every claim is related to the patient’s age, type of payer, and a specific coding framework.
Well-child visit codes are split across six age bands. A single mismatch of the patient’s age and the CPT code used is a direct denial.
Every immunization visit includes a product code and a separate administration code, which are often missed. A software will prevent it.
The majority of the pediatric patients have both Medicaid and private insurance, which makes it necessary to use the correct COB sequencing.
MedCare MSO’s pediatric billing software manages your entire revenue cycle from eligibility verification to charge capture using AI-powered workflows. Claim scrubbing, submission, and payment posting, everything our software does is through automation that saves time and provides the best precision. Also, the software is customized to follow pediatric-specific coding rules, compliance standards, and payer requirements to guarantee 100% compliance.
Already using a pediatric platform for your billing? No need to switch as our pediatric billing software is capable of integration with EHR and practice management systems seamlessly.
Every workflow, claim submission, data transfer runs fully on a HIPAA-compliant infrastructure with a complete audit trail.
Every claim the software submits goes through a 3-million-rule engine which keeps your first-pass acceptance rate high.
Is your organization operating in multiple locations? No worries, our software consolidates all locations into one dashboard.
Got aging claims with high AR Days? Get a free AR analysis from MedCare MSO and know how you can recover.
Yes, the software is capable of billing for both visit types on the same day. Our pediatric billing software detects the combination and applies Modifier 25 to the E/M code automatically which ensures both services are billed correctly.
Yes, we do offer a complete walkthrough of our billing software and explain how it can be beneficial for your pediatric practice. We show all workflows that will help you save time and provide better accuracy so that you can understand how much value our software has to offer.
Our software automatically identifies patients who have dual coverage including Medicaid and private insurance to sequence the claim in the correct filing order. This makes sure that your practice collects without any problems with COB.
Our software does a great job in applying payer-specific rules for Medicaid, commercial insurers, and CHIP on every claim. Each payer’s coding requirement, documentation standards, and modifier rules are separated by payer so that claims are submitted with the payer-specific rules.
VFC-enrolled patients follow a separate billing flow inside MedCare MSO’s pediatric billing software. Product codes are flagged at zero cost for VFC-supplied dose automatically, validation is there for administration codes, and Modifier SL is appended where required. This way vaccine billing is done the right way, and it stays compliant without manual intervention.
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